rr- 



1229 



TX 



Issued February 4. 1910. 

U. S. DEPARTMENT OF AGRICULTURE. 

OFFICE OF EXPERIMENT STATIONS— BULLETIN 223. 

A. C. TRUE, Director. 



DIETARY STUDIES IN PUBLIC INSTITUTIONS 
IN PHILADELPHIA, PA., 



BY 



MISS EMMA SMEDLEY and R. D. MILNER. 



AND 



DIETARY STUDIES IN PUBLIC INSTITUTIONS 
IN BALTIMORE, MD., 



BY 



H. L. KNIGHT, H. A. PRATT, and C. F. LANGWORTHY. 





WASHINGTON: 

GOVERNMENT PRINTING OFFICE. 
1910. 






ty\> 




Class _J_ 

Book Q 6 . 






1229 



Issued February 4, 1910. 



U. S. DEPARTMENT OF AGRICULTURE. 

OFFICE OF EXPERIMENT STATIONS— BULLETIN 223. 

A. C. TRUE, Director. 



DIETARY STUDIES IN PUBLIC INSTITUTIONS 
IN PHILADELPHIA, PA., 



BY 



MISS EMMA SMEDLEY and R. D. MILNER, 



AND 



DIETARY STUDIES IN PUBLIC INSTITUTIONS 
IN BALTIMORE, MD., 



BY 



H. L. KNIGHT, H. A. PRATT, and C. F. LANGWORTHY. 




WASHINGTON: 

GOVERNMENT PRINTING OFFICE. 

1910. 






OFFICE OF EXPERIMENT STATIONS. 

A. C. True, D. Sc, Director. 

E. W. Allen, Ph. D., Assistant Director and Editor of Experiment Station 
Record. 

O. F. Langwokthy, Ph. D., Expert in Nutrition. 

(2) 



f- > 11 1910 



LETTER OF TRANSMITTAL 



U. S. Department of Agriculture, 

Office of Experiment Stations, 
Washington, D. C, October 15, 1909. 
Sir : I have the honor to transmit herewith, and to recommend for 
publication as Bulletin No. 223 of this Office, a report on the results 
of 8 dietary studies in homes for the aged and 3 in orphan asylums 
in Philadelphia and Baltimore, carried on by R. D. Milner, Miss 
Emma Smedley, H. L. Knight, H. A. Pratt, and C. F. Langworthy. 
The institutions were of two types, namely, those supported by 
public funds and those supported largely by private endowment. 

One object of the investigation was to secure data regarding the 
food consumption of aged men and women and children for use in 
formulating dietary standards for such individuals, in comparison 
with an adult man in full vigor. It is often a matter of great impor- 
tance, particularly in the expenditure of public funds, to determine 
whether the diet of an institution corresponds in all respects to reason- 
able standards, and one of the principal objects of the investigation 
here reported was to test the value for making such comparisons of 
methods elaborated in cooperation with the nutrition investigations of 
this Office. The results indicate that the object sought can be attained, 
and demonstrate that with the data now available it is possible for 
the nutrition expert to pass upon the dietary problems of an insti- 
tution in the same way that a public accountant can pass upon the 
financial affairs of a commercial enterprise, and it seems fair to say 
that the data obtained are as useful in the one case as in the other. 

Acknowledgment should be made to the managers of the several 
institutions studied and to the matrons and other officials for making 
the work possible and aiding it in many ways. 

Respectfully, A. C. True, 

Director. 
Hon. James Wilson, 

Secretary of Agriculture. 
(3) 



CONTENTS. 



Page. 

Dietary studies in Philadelphia 7 

Introduction „ 7 

.Dietary study in old ladies' home 7 

Staple foods and methods of serving 8 

Method of making the dietary study 9 

Details of the dietary study 9 

Discussion of results 10 

Dietary study in an orphan asylum 11 

Method and results of the dietary study 13 

Discussion of results 14 

Dietary studies in Baltimore 15 

Introduction 15 

Composition of food materials and waste 15 

Dietary studies at Bay view Asylum 17 

Staple foods and methods of serving 19 

Menus for the different wards _ 21 

Methods of making the dietary studies 24 

Dietary studies Nos. 682 and 683, men's dining room, regular patients 

and stable hands and chronic and special diet patients « 24 

Dietary study No. 684, women's dining room 31 

Dietary study No. 685, men's receiving ward . 34 

Waste 35 

Amount eaten per person as shown by total amounts purchased 36 

Cost of the food 39 

Results of dietary studies at Bay view 40 

Dietary studies in homes for the aged and orphan asylums under private 

management 46 

Dietary study No. 686 47 

Dietary study No. 687 54 

Dietary study No. 688 59 

Dietary study No. 689 64 

Dietary study No. 690 69 

The dietary studies with the aged and their results 75 

Dietary requirements of the aged 75 

Food in Baltimore and Philadelphia homes for the aged compared 

with other institutions and standards 83 

Dietary studies with children and their results 87 

(5) 



DIETARY STUDIES IN PUBLIC INSTITUTIONS. 



DIETARY STUDIES IN PHILADELPHIA. 

By Miss Emma Smedley and It. D. Milneb. 
INTRODUCTION. 

As a part of the nutrition investigations of the Office of Experi- 
ment Stations, dietary studies were made in a home for aged women 
and in an orphan asylum in Philadelphia, the results of which are 
here reported. The work was carried on in cooperation with Drexel 
Institute and was undertaken primarily to secure data regarding the 
food consumption of aged persons and children and also as a demon- 
stration of the importance of such studies as a means of judging of 
the effectiveness of the system of institution management followed 
and the nutritive value and character of the diet in comparison with 
dietary standards. 

DIETARY STUDY IN OLD LADIES' HOME. 

The home for aged women in which this study was made is under 
the care of a benevolent association. In January, 1907, the home 
celebrated its ninetieth anniversary. During its many years of use- 
fulness it has had as its managers many able women, and not a few 
of the present managers are granddaughters or great-granddaughters 
of the organizers of the society. 

The building now occupied was erected in 1887. It is large, com- 
modious, and surrounded by a spacious yard, in which are many 
trees and a flower garden. It is so arranged that all the rooms occu- 
pied by the old ladies are sunny a part of the day. On each floor 
there are sitting rooms for the inmates, and a library has been pro- 
vided for them. One section of the second floor is used for an infir- 
mary, where the feeble and sick may be made more comfortable 
under the care of a trained nurse and her assistants. 

There were 113 old ladies in the asylum at the time the dietary 
study was made, 10 of whom were between the ages of 65 and 70, 73 
between 70 and 80 years, 20 between 80 and 90 years, and 10 between 
90 and 100 years. 

(7) 



8 

The employees consisted of a matron and 1 assistant; a trained 
nurse and 5 assistants; 12 women, including cooks, laundresses, and 
housemaids ; and 3 men, an engineer and his assistant and a " chore " 
man. One man was away at the time of the dietary study. 

The general health and happiness of the whole family was re- 
markably good. The old ladies assist in preparing the vegetables 
for the table, and sew or perform other light duties about the house 
in so far as they are able. 

STAPLE FOODS AND METHODS OF SERVING. 

The matron buys all food, selected according to the market supply, 
under the direction of the managers. She also arranges the menus 
and gives her personal oversight to the preparation and serving of 
the meals. There is more variety in the diet than is usually found 
in an institution; it is like a home table, and the food is well pre- 
pared, attractive, and appetizing. 

All food is prepared in the basement kitchen and carried by dumb- 
waiter to the main dining room on the first floor and to the infirmary 
on the second floor. The same food is served to all of the employees. 
Extra dishes, as beef tea, mutton broth, albumen water, and gruels 
are prepared in the infirmary for those requiring special diet. 

The bread is supplied by a baker who makes it in 2-pound loaves, 
8 loaves to a pan, thus avoiding a large amount of crust which would 
probably be wasted. 

Coffee, tea, and milk are always served for breakfast, tea or coffee 
and milk for dinner, and tea and milk for supper. 

An examination of the menus showed that rice is served nearly 
every day as well as potatoes and a green vegetable, the rice sometimes 
taking the place of dessert, when it is eaten with sugar and milk. 

Meat left from dinner is usually served to the few who wish it for 
supper. Koast beef is always served cold for dinner on Sunday. 
Cake of some kind is served Sunday night in place of the hot dish 
which is used on week days. 

Food is allowed in unlimited quantities, and the fact that there is 
remarkably little waste from the table proves that it is appetizing. 

The following is a representative sample of the menus used during 
the week of the study: 

Menu for Tuesday, May 14. 

Breakfast : Oatmeal, dry flaked cereal, chipped beef, potatoes, bread and but- 
ter, tea, coffee, milk, sugar. 

Dinner : Fried ham, mashed potatoes, lettuce and dressing, boiled rice, coffee, 
bread and butter. 

Supper : Corn muffins, butter, tomato preserves, tea, milk. 



METHOD OF MAKING THE DIETARY STUDY. 

As all food is prepared in one kitchen, it was necessary to record 
only the weights of food materials on hand at the beginning of the 
study, as bread, butter, milk, sugar, and meat; all supplies purchased 
or taken from the storeroom during the week, and, at the end of the 
week, the weights of materials on hand. Meat was weighed as pur- 
chased and vegetables as prepared for cooking. Many loaves of 
bread were weighed and the average weight used in the calculations. 
The same method was employed for cereal breakfast foods which were 
purchased in boxes. 

The weight of table waste was also recorded each day. 

From these figures are calculated the nutritive value of the food 
served and wasted per person per day. 

It was not thought necessary to analyze any food materials, the 
composition being assumed from a previous publication. The figures 
in parentheses following the names of food materials in the table on 
page 10 refer to manuscript tables on file in this Office showing the 
data thus used. 

The fuel value of the foods used was calculated by the use of factors 
given in Principles of Nutrition and Nutritive Value of Foods. 6 

It was assumed that the composition of the total waste was the 
same as the average composition of the total food supplied. 

DETAILS OF THE DIETARY STUDY. 

This study covered a period of seven days, beginning May 14, 1907, 
during which time 2,811 meals were served, 2,365 to the old ladies, 
406 to the women employees and occasional visitors, and 40 to the men 
employees. 

Several old ladies and a number of the employees were away one 
or more meals during the week. 

The total food materials used, with their cost and nutrients, are 
given in the table on page 10, at the end of which are also given the 
cost and nutrients supplied per woman per day. 

To determine the amount of food eaten b}^ the employees, it was 
assumed that each man consumed 125 grams of protein, 125 grams of 
fat, and 400 grams of carbohydrates per day, and each woman 0.8 of 
this amount. The amounts of nutrients thus estimated were sub- 
tracted from those of the total food to give the amounts actually eaten 
by the inmates, and from these last the amounts per woman per day 
were calculated. It was impossible to distinguish between employees 
and inmates in considering the daily cost, which is, therefore, calcu- 
lated per person per day. 

a U. S. Dept. Agr., Office Expt. Stas. Bui. 28 revised, and Farmers' Bui. 249. 
& U. S. Dept. Agr., Farmers' Bui. 142. 



10 



Weight, cost, nutrients, and fuel value of total food and that consumed per 
xooman per day, dietary study No. 691. 



Kinds, amounts, and cost of material. 


Cost. 


Protein. 


Fat. 


Carbo- 
hydrates. 


Fuel 
value. 


ANIMAL FOOD. 

Beef, veal, and mutton: Beef, chipped, dried, 12.8 
pounds, $2.30 (1); ribs, 112 pounds, $17.92 (3); rump 
steak, 37.5 pounds, $6.66 (2); veal, liver, 11 pounds, 
$2 (6); lamb, chops, 10 pounds, $1.80 (4); shoulder, 
39.5 pounds, $6.22 (5) 


Dollars. 
36.90 

7.88 

12.95 
9.50 

53.51 


Grams 
15, 754 

2,496 

6,775 
4,102 

15,056 


Grams. 
18, 653 

10,902 

4,617 
3,206 

45,015 


Grams. 


Calories. 
229, 029 

107,014 

68,410 


Pork, etc.: Bacon, 17 pounds, $2.89 (7); ham, with 
bone, 23.8 pounds, $3.80 (8); salt pork, 6 pounds, 
$0.90 (9); lard, 2.5 pounds, $0.29 (10) 




Fish, etc.: Mackerel, 19 pounds, $2.85 (12); shad, 64 
pounds, $10 (11); oysters, canned, 3 pounds, $0.10 
(62) 


53 


Eggs, 76 pounds, $9.50 (14) 


44, 944 
547, 137 


Dairy products: Butter, 71.5 pounds, $27.17 (15); 
buttermilk, 30 pounds, $0.36 (16); cheese, 4 pounds, 
$0.62 (18); milk, 922 pounds, $25.36 (17) 


21,570 








120. 74 


44, 183 


82, 393 


21,623 


996, 534 




VEGETABLE FOOD. 

Cereals: Barley, pearled, 1.3 pounds, $0.05 (20); 
corn meal, 21 pounds, $0.42 (26); oatmeal, 21 pounds, 
$0.63 (19); rice, 13.5 pounds, $0.95 (24); wheat flour, 
61.3 pounds, $1.54 (25); farina, 5 pounds, $0.35 (22); 
breakfast food, 9 pounds, $1.10 (32); bread, white, 
146 pounds, $5.48 (27); bread, graham, 48.5 pounds, 
$1.70 (28); breakfast rolls, 18 pounds, $0.96 (29); 
cake, Dutch, 21 pounds, $1.12 (30); cookies, sugar, 
5.5 pounds, $0.55 (31); macaroni, 3.5 pounds, $0.28 
(33) 


15.13 
9.60 

12.62 

14.48 

.75 


15,891 
22 

4,900 
871 


3,773 


102,863 
85, 894 

26, 101 
18,516 


508, 599 


Sugars and starches: Molasses, 2 pounds, $0.12 (35); 
sugar, granulated, 185.5 pounds, $9.27 (34); corn- 
starch, 2.8 pounds, $0.21 (36). .. 


343,663 


Vegetables: Beans, pea, dried, 10 pounds, $0.45 (37); 
beans, Lima, 7.8 pounds, $0.47 (38); cabbage, 39.5 
pounds, $1.30 (39); lettuce, 32.5 pounds, $1.70 (41); 
onions, 2.5 pounds, $1 (43); potatoes, 188.5 pounds, 
$3 (45); potatoes, 44 pounds, $1 (46); radishes, 3.8 
pounds, $1 (47); spinach, 52 pounds, $2.60 (48); 
tomatoes, 1 pound, $0.10 (50) 


416 

430 
454 


127,702 


Fruits: Bananas, 78 pounds, $2.88(54); rhubarb, 24.5 
pounds, $1.50 (58); strawberries, 70 pounds, $7.85 
(60); plums, canned, 25 pounds, $1 (57); prunes, 10 
pounds, $0.75(56); tomatoes, preserved, 20.5 pounds, 
$0.50 (58) 


81,375 


Olive oil, 1 pound, $0.75 (61) 


4,041 










Total vegetable food 


52.58 


21,684 


5,073 


233,374 


1,065,380 






Total food 


173. 32 


65, 867 
5,070 


87, 466 
6,854 


254,997 
19,906 


2,061,914 


Waste 


160,910 








Total food consumed 




60, 797 
15,313 


80,612 
15, 313 


235, 091 
55,007 


1,900,995 


Food of employees 




417,561 








Food consumed by inmates 




45, 484 


65,300 


180,083 


1, 483, 434 










a. 18 


58 


83 


228 


1,882 







a Per person per day; see page 9. 
DISCUSSION OF RESULTS. 

According to the table each inmate of the home received during 
the time of the study 58 grams of protein and 1,882 calories of energy 
a day, at a cost of 18 cents. The amounts of nutrients thus supplied 
are noticeably lower than those in the Baltimore studies reported else- 
where in this bulletin, or than almost any others on record in the in- 
vestigations of this Office for persons of similar requirements. Since 
there was no limit to the amount of food served it is evident that the 



11 

subjects satisfied their hunger, and the comparatively small table 
waste seems a proof that they found the food appetizing. The ques- 
tion of the adequacy of the diet to their needs is discussed in another 
section of this bulletin (see p. 40). 

The cost, 18 cents per person per day, is not excessive, considering 
the variety of foods served. If the strictest economy were necessary, 
materials could undoubtedly be selected which would furnish as large 
quantities of nutrients for a smaller sum or larger quantities for the 
same sum, but probably not with as appetizing a variety, especially in 
the matter of fruit and vegetables. Such pleasing variety in the diet 
actually adds to its nutritive value by stimulating the flow of diges- 
tive juices, a consideration of especial importance in the case of per- 
sons in whom, as in the subjects of this study, the vital processes tend 
naturally to become sluggish. 

In general, it may be said that the diet was in reasonable accord 
with commonly accepted standards and that the dietary problems 
were handled in accordance with the requirements of good manage- 
ment. The food was adequate, well prepared and served, and the cost 
reasonable as compared with the resources. 

DIETARY STUDY IN AN ORPHAN ASYLUM. 

The orphanage where the dietary study was made is located in a 
suburb about 13 miles from Philadelphia. It is under management 
similar to the home for old ladies in which dietary study No. 691 was 
carried on. At its foundation in 1814 it was the only institution of 
the kind in Philadelphia, and it has always occupied a high place 
among public institutions of the city. In 1906 it moved into its pres- 
ent quarters, where it has the advantages of country surroundings. 

The buildings, admirable in their external construction and an 
ornament to the neighborhood, have proved thoroughly adapted to the 
purposes of the asylum. Well lighted and well ventilated, and pro- 
vided with every convenience, they furnish to the children the same 
provisions for comfort and health which would be expected in a pri- 
vate house. The surrounding grounds afford opportunity for exercise 
in the open air and for instruction in farming and gardening. 

The children have a very free and happy life, and were all in ex- 
cellent health. All who are over 6 years old attend school each day 
in a school maintained in the asylum, where, beside their regular 
studies, the boys receive instruction in carpentry and the girls in 
sewing, housework, and stenography. Besides going to school each 
child has some regular household duty to perform, under the super- 
vision and instruction of a care taker. The girls do all the work in 
their dormitories and halls, help in the kitchen, dining rooms, and 
laundry, wash all the dishes, and have care of the pantries. The 
older girls do their own sewing and also help with the mending for 



12 

the smaller girls. The boys take care of their dormitories and halls, 
carry coal for the cook, and assist the man in the care of the lawn and 
garden. The boys are also taught to sew and the older ones mend the 
stockings for the younger ones. Each older boy and each girl is 
made responsible for the conduct of a younger child. The family 
feeling is especially encouraged, and the matron endeavors to give the 
children a mother's care and sympathy. 

There were 80 children in the home at the time the study was made, 
their ages ranging as follows: 

Number and age of children in orphan asylum. 



Girls. 


No. 


Boys. 


No. 


Between 15 and 18 years 


8 
10 

8 
11 

7 

44 


Between 13 and 14 years 


6 






5 






4 






14 


Under 6 years 


Under 6 years 


7 


Total girls 


Total boys 


36 









The average age of the girls was a little less than 11 years ; that of 
the boys a little less than 9 years. 

The officers of the home, 11 in all, at the time the study was made, 
included a matron and assistant, 2 teachers, nurse, seamstress, and 5 
care takers. A cook, 3 laundresses, and 1 man were also employed. 

The matron buys most of the table supplies in Philadelphia. Milk, 
which furnishes the largest item in the menu, is supplied from a well- 
equipped dairy in the neighborhood. Green vegetables and eggs are 
also purchased from a neighboring farm. 

The meals are served at regular hours each day, and half an hour 
is allowed for each meal, the children being allowed all they will eat 
in that time. The matron and caretakers are always in the dining 
room while the children are eating, to help the little ones and to 
encourage all to be neat, careful, and thoughtful. 

The diet of the children is very simple, as will be gathered from the 
menu for a representative day. They are not allowed to have food 
between meals, except occasionally as a treat. 

The officers' meals are served in another room after the children are 
through, and their food is different from that served to the children. 
The other employees are also given a diet slightly different from that 
of the children. The menu for the children for a representative day 
during the time of the study, May 18 to May 24, 1907, was as follows : 

Menu for Saturday, May 18. 

Breakfast : Oatmeal, milk, sugar, bread, butter. 

Dinner : Frizzled beef, hard-boiled eggs, bread, butter, milk. . 

Supper : Stewed peaches, bread, butter, milk ; pudding to a few older girls. 



13 

METHOD AND RESULTS OF THE DIETARY STUDY. 

In order to avoid the confusion which might otherwise arise be- 
tween the food served to the children and that served to the officers 
and employees, all the materials served to the children were measured 
just before serving. The table waste from each kind of food was also 
separately measured and subtracted from the amount served. The 
results of the study as given in the table below therefore represent 
the amounts actually eaten by the children. 

The composition of the food materials was assumed from data in 
earlier publications.® The significance of the figures in parentheses 
in the table was explained on page 9. 

It was not feasible to include the cost of food in the observations 
made during this study, as so much of the food, i. e., milk and garden 
produce, was of home production. 

The study covered a period of seven days, beginning May 18, 1907. 
There were 80 children at the orphanage for the first four days, when 
one girl became of age and left the home. All calculations are there- 
fore made for 79.5 children for one week, or one child for 556.5 days. 

The detailed results of the study are given in the following table : 



Weight of total food and nutrients and fuel value' per child per day, 

study No. 692. 



dietary 



Kinds and total amounts of food materials. 



Per child per day. 



Protein. 



Fat. 



Carbo- 
hydrates. 



Fuel 
value. 



ANIMAL FOOD. 

Beef: Dried, chipped, 5 pounds (1); rump, steak, and stew, 41 
pounds (2); ribs, 16.5 pounds (3) 

Lamb: Shoulder, 16 pounds (5) 

Pork: Salt, 5.5 pounds (9) 

Fish: Cod, fresh, 18 pounds (13) 

Eggs: 5.75 pounds (14) 

Dairy products: Butter, 14.75 pounds (15); milk, 823.75 pounds 
(17) 



Grams. 
8.1 
1.8 



1.1 

.6 

22.3 



Total animal food. 



VEGETABLE FOOD. 

Cereals: Oatmeal, 16.75 pounds (19); cream of wheat, 18.25 
pounds (23); com flakes, 4 pounds (21); rice, 2 pounds (24); 
wheat flour, 5 pounds (25); white bread, 272.75 pounds (27); 
cookies, 11 pounds (31); rice pudding, 4 pounds (63) 

Sugars and starches: Cornstarch, 0.75 pound (36); molasses, 
0.5 pound (35); sugar, 52 pounds (34) 

Vegetables: Beans, pea, dried, 12.5 pounds (37); corn, canned, 
20.5 pounds (40); cucumbers, 20 pounds (42); onions, 2.5 
pounds (43); peas, canned, 41.5 pounds (44); potatoes, 137 
pounds (45); string beans, canned, 6.75 pounds (49); tomatoes, 
canned, 21 pounds (51) 

Fruits: Strawberries, fresh, 18 pounds (60); apples, dried, 7.5 
pounds (53); peaches, dried, 6.75 pounds (55) 



Total vegetable food. 
Total food 



34.2 



26.2 



67.6 



Grams. 



2.0 
2.5 



Grams. 



.4 
37.1 



51.8 



6.1 



57.9 



33.6 



Calories. 
120 
25 
23 

4 



554 



33.6 



152.9 
43.2 



34.7 

5.7 



236.5 



270.1 



732 



764 
173 



172 

26 



1,135 



1,867 



a U. S. Dept. Agr., Office Expt. Stas. Bui. 28, revised, and Farmers' Bui. 249. 



14 

DISCUSSION OF RESULTS. 

It is ordinarily assumed that children the ages of those in this study 
or a trifle older require 0.6 of the amount required by a man at mod- 
erately active work. This would mean about 63 grams of protein 
and 2,100 calories of energy. The present study falls a little below 
this in energy, but shows 5 grams more protein. The general ques- 
tion of the food requirements of children and the adequacy of the 
diet in this and similar studies is discussed in a later section of the 
bulletin (see p. 87). 

As regards the variety of materials used, the list presented in the 
table (p. 13) speaks well for the judgment of the purveyor. There 
is a greater variety of meats than in many such institutional dietaries, 
and also of vegetables and fruits. No data are available regarding 
the cost, but it is known not to have been beyond the means of the 
establishment, and undoubtedly provided a pleasing diet for the 
children. 

As was the case in the Philadelphia home for aged women, the 
diet was adequate, whether judged by the nutrients and energy it 
supplied in comparison with commonly accepted dietary standards 
or by the physical condition of the children. The food was simple — 
as should be the case, particularly with children — and was wholesome 
and reasonable in cost, and was prepared and served with care and 
due regard to good standards. 



DIETARY STUDIES IN BALTIMORE. 

By H. L. Knight, H. A. Pratt, and C. F. Langworthy. 
INTRODUCTION. 

The following report comprises the results of a group of dietary 
studies made in charitable institutions for the aged and for the 
orphaned in Baltimore, Md. One object was the same as that of 
previous studies made in public institutions as a part of the nutrition 
investigations of the Office of Experiment Stations, namely, to secure 
accurate data regarding dietary conditions in comparison with the 
commonly accepted standards, in order that the management might 
know how satisfactory was the system followed and whether the food 
was adequate and met other reasonable requirements. There was, 
moreover, the further purpose of obtaining more information regard- 
ing the food consumption of elderly persons and children. Some 
investigations have been made in Europe regarding the nutritive 
demands of the aged, and from the data thus obtained it has been 
assumed that persons in the decline of life require 0.8 of the food of 
younger adults in corresponding circumstances, but this factor needs 
further verification. Even less investigation has been made regard- 
ing the food requirements of children beyond the age of infancy. It 
is evident that additional information on these points will be of 
immediate value to both the practical dietitian and the physiologist. 

The institutions in which the present studies were carried on are 
believed to be typical of their respective kinds, namely, charitable in- 
stitutions where rigid economy is absolutely essential, and institutions 
which are not of this character, but are rather to be considered as 
homes for aged persons and for orphan children, in which they may 
have the care and the comforts which are possible with more abundant 
resources. Bayview, the Baltimore city almshouse, in which the 
first series was made, is perhaps typical of public institutions where 
economy is essential. The next three studies were conducted in a 
home for aged women, a home for aged men, and the German Aged 
People's Home (Allgemeine Deutsche Greisenheimat) , institutions 
under private management. The remaining two studies were made 
in children's homes, the Maryland Home for Friendless Colored 
Children, and the German Orphan Asylum (Allgemeines Deutsches 
Waisenhaus). In all cases the studies were carried on with the full 
consent of the managers and the helpful cooperation of the officials 
of the homes. 

COMPOSITION OF FOOD MATERIALS AND WASTE. 

The foods used in these studies were for the most part so simple 
and similar to those in common use in this country that it was deemed 

(15) 



16 

unnecessary to analyze them. The composition of almost all was, 
therefore, assumed from previous analyses of similar materials given 
in earlier publications of this Office. Composite samples of the 
waste from each of the last five studies and of samples of certain 
ingredients of the waste in the Bayview studies were, however, espe- 
cially analyzed, as were also a few food materials. Only the percent- 
age of protein was found in these analyses, which was obtained by 
multiplying the percentage of nitrogen by the factor 6.25. The heats 
of combustion were determined by the use of a bomb calorimeter, and 
from that the fuel value or energy was computed by means of the 
factors of availability commonly used in dietary studies.® 

The table below gives the analyses specially made. In the detailed 
results of dietary studies which follow a reference number is given in 
parentheses after each material. These numbers refer either to this 
table or to manuscript tables kept on file in this Office, in which are 
shown the previous analyses which are assumed to represent the 
chemical composition of these materials. 

Protein, heat of combustion, and fuel value of materials analyzed, dietary 

studies Nos. 682-690. 



Refer- 
ence 
num- 
ber. 



Food materials. 



Protein 
(NX6.25). 



Heat of 
combus- 
tion per 
gram. 



Fuel 
value per 
pound, b 



ANIMAL FOOD. 

Beef, "sides and rattlers," cooked, edible portion. 

VEGETABLE FOODS. 

Cereals: 

Oatmeal, boiled 

Rice, boiled 

Bread , rye 

Bread, wheat 

Cake 

Vegetables: Cabbage sorouts, boiled 

Fruits: 

Apple butter 

Apple sauce (evaporated apples) 

Do 



MISCELLANEOUS FOODS. 

Soup: 

Chicken 

Vegetable 

Mutton, with vegetables 

Beef, with vegetables 

Do 

Do 

Average, Nos. 12, 11, 15, and 16 

Gravy, for meat 



WASTE. 



Broth, waste from soup, studies Nos. 682-685 

Composite sample, study No. 686 

Composite sample, study No. 687 

Table waste, composite sample, study No. 688 .. . 
Kitchen waste, composite sample, study No. 688 . 

Composite sample, study No. 689 

Composite sample, study No. 690 



Per cent. 
28.8 



1.1 
1.0 
10.6 
9.8 
8.1 
4.0 

c.5 
.3 
c.3 



8.0 
2.5 
6.0 
1.4 
6.9 
4.1 
d4.9 
1.9 



.8 
5.3 
4.7 
1.7 
4.3 
5.2 
3.6 



Calories. 
3.059 



c.112 
.990 
c.561 



1.078 
.865 
.713 
.550 

1.188 
.834 

d.859 
.795 



.128 
1.432 
1.350 

.496 
1.104 
1.645 
1.140 



Calories. 
1.207 



.153 

.228 

1.246 

1.024 

1.782 

.412 



.444 
.395 
.224 



.421 
.337 
.278 
.215 
.463 
.325 
.335 
.310 



.50 

.598 

.563 

.207 

.461 

.687 

.476 



all. S. Dept. Agr., Office Expt. Stas. Bui. 152, p. 13. For waste 92 per cent was taken, the figure there 
given for combination meals; for apple butter, 98 per cent, the figure for sugar. 
b Calculated from heat of combustion per gram. 

c Protein assumed from previous analysis; heat of combustion determined. 
d Estimated. 



17 

DIETARY STUDIES AT BAYVIEW ASYLUM. 

The data for this series of studies were collected by Mr. H. A. Pratt, 
at Bayview Asylum, Baltimore, Md., in May, 1905, the investigation 
being carried on Avith the cooperation of the board of charities, to 
find the existing food consumption, the character of the food supply, 
and the methods of cooking and serving food, with a view to making- 
suggestions for improvements if necessary and possible, and to obtain 
data regarding the food consumption and requirements of elderly 
men and women, the population of Bayview being largely composed 
of such persons. This institution, which is pleasantly located in 
the eastern suburbs of Baltimore, overlooking Patapsco Bay, is the 
almshouse of Baltimore, and is under the direction of the city board 
of charities. To it are admitted those of the city poor who are unable 
to support themselves and have no one on whom they can depend, 
and also poor people who are unfit to care for themselves by reason 
of physical or mental disability. While not primarily an insane 
asylum, Bayview, at the time of the study, admitted the pauper 
insane of the city and cared for them in a separate ward. The State 
has since taken over such patients. The report of the city board of 
charities for 1904 says : 

There has been a difficulty in securing a recognition of the proper function 
of Bayview as an infirmary and hospital. It is neither a reformatory nor a 
penal institution. It is intended for persons who are sick, infirm, or aged, 
who are unable to support themselves or to find others to support them. It 
is not intended for the able-bodied or for persons in need of reformation. 

The average population of Bayview in 1904 was about 1,348, of 
whom 625 were insane and hospital patients, and the majority of 
the remainder (723) aged men and women. The population is, how- 
ever, very variable, being larger in winter than in summer, since 
there are always, as in all cities, a certain number who seek public 
shelter during the cold winter. It is also true that a considerable 
number of the inmates work on farms during the summer and return 
after the farming season. At the time of the study the inmates were 
very largely persons ranging from middle life to old age, the number 
of men and women being about equal, and there were many infirm 
and maimed or crippled persons among the number. The large 
number of hospital patients consisted not only of the persons who 
became ill while inmates of the institution, but also of pauper patients 
transferred from the city hospitals. 

The inmates did nearly all the work of the institution, both indoors 
and on the institution farm. This is over 200 acres in extent and 
yields a large part of the vegetables consumed by the inmates and 
employees. A number of those who did regular work received wages 
for their services. No work was carried on at Bayview except that 
16553— Bull. 223—10 2 



18 

incident to the operation of the institution — that is, nothing was 
manufactured for sale. 

The institution life of the inmates was very regular. They rose 
early in the morning, the rising bell ringing at about 5.30 a. m. 
They also retired early, the great majority being in bed before 9 
o'clock, the official time for " lights out." The meals were served 
at regular hours, although the hours in each division of the institution 
were not precisely the same, and the women ate breakfast somewhat 
later than the men. On Sundays supper was served earlier than on 
the other days of the week. Religious services were conducted daily 
by different church organizations, and occasional entertainments 
were provided by various charitable organizations in the city for 
the amusement of the patients. 

All matters pertaining to the management of Bayview have re- 
ceived very careful attention from supervisors of city charities and 
from the institution officials. Several years before the studies were 
made the dietary question was carefully considered by one of the 
members of the board who had had a great deal of experience in the 
study of nutrition problems. As a result the rations now supplied 
were determined upon because they were believed to meet the require- 
ments of the subjects and to conform to the commonly accepted dietary 
standards, while al (lie same time they were reasonably varied and 
palatable and came within the sum available for food expenditures 
per person per day. The dietary as thus arranged has proved fairly 
satisfactory, as was shown by the fact that the inmates retained their 
accustomed health and. strength to a noticeable degree, considering 
the large proportion of aged and infirm. 

The buildings of the institution were well adapted to their several 
purposes, though at the time of the studies somewhat overcrowded. 
They were particularly noticeable for the neatness and cleanliness 
everywhere evident. The main building, which was the one in which 
the dietary studies were made, was of brick, four stories high, one 
wing being used for male and the other for female inmates. Each 
section had its hospital and its sun parlors in addition to dormitories, 
dining room, lavatories, etc. The official force had their living rooms 
and dining rooms in the center of the main building, and there were 
also one or two large public rooms. 

A part of the food supplied to the divisions studied was cooked in 
the "diet kitchen," but the greater portion in the so-called "county 
kitchen." The " diet kitchen " was situated in a wing in the rear of 
the building and was especially equipped for its purpose. From it 
was served a part of the menu for the regular inmates and also for 
the hospital patients of the institution. The " county kitchen," in 
(he basement of the main building, was the principal kitchen of the 
institution, and most of the food for the inmates was cooked there. 



19 

It was of good size, clean, and orderly, and seemed to answer its pur- 
pose very well. All the workers in this kitchen, including the head 
cook, were inmates. The bakery of the institution, where all the 
bread used is baked, was also well equipped. It was situated in the 
basement of the main building, directly back of the " county kitchen." 

STAPLE FOODS AND METHODS OF SERVING. 

Some observations in regard to the staple foods of the institution 
and the way they are served are of interest, preliminary to a consid- 
eration of the dietary studies. 

In general, it should be said that the officers of the institution made 
a special effort to see that all the provisions purchased were of the 
very best quality that could be secured with the funds at their 
disposal. 

All foods which were purchased were bought under contract if 
the amount exceeded 500 pounds. The number of cooked articles 
served to the inmates' was Comparatively smal], bread, coffee, and soup 
being the three staple articles of diet. For two or three weeks in 
the spring and during the time of these studies, fish and coffee were 
served in place of the soup on Fridays. Otherwise, the soup, which 
should more properly be called a stew, was cooked and served every 
day of the week except Sunday. As a rule this soup was made of 
beef and vegetables, though mutton was used in place of beef one day 
in each week, either Friday or Saturday. Two methods of making 
the soup were followed. On Mondays and Thursdays the meat was 
boiled, cut from the bones, and after being apportioned in lots suit- 
able for the different dining rooms, was placed in kettles, where it 
was kept hot until served, becoming in the meantime more or less 
brown and savory, so that it resembled a pot roast. A gravy was 
provided for the meat in some but not in all of the dining rooms. 
Into the stock from the boiled meat were put the vegetables which 
always made up a part of the dinner — potatoes, carrots, onions, etc. 
These were then boiled and the soup, or broth, i. e., stock plus vege- 
tables, was apportioned to the several dining rooms. The meat was 
served on plates, a ration to a person, while the broth was served in 
tin cups. This entire dinner was called " soup " at the institution, 
and is so called throughout this report, though the meat was served 
entirelv separate from the broth. 

On other days the soup was made in the usual way, that is, the 
meat was cooked, then boned, and replaced in the kettle with the po- 
tatoes and other vegetables. To prevent its breaking up too much 
the cooked meat was not added until the vegetables were partly done. 
A small quantity of flour was added to the soup to thicken it slightly, 
and salt and pepper were of course used. This soup was very palata- 
ble, resembling stew rather than soup, and seemed on the whole to be 



20 

well liked. In this case the meat and broth were served together. 
In general, the thicker the soup, that is, the more meat and vegetables 
it had in it, the better it was relished. 

The beef which the institution used was mostly the portions known 
as " sides and rattlers," the better cuts of the former being reserved 
for the officers and employees. It was purchased from Baltimore 
dealers. While economy demanded that the meat be cheap, it ap- 
peared to be of good quality. It was always subjected to a careful 
inspection by the steward before being received. Fresh roast pork, 
raised at the asylum, was served on Sundays during the winter season 
in place of the smoked pork shoulder. 

The use of fish was rather restricted at Bayview. During part of 
the year the women inmates who worked received salt herring for 
breakfast one morning each week. In general, fresh fish was not 
supplied, but in the spring, when fresh herring were in season, they 
were served baked for the Friday dinner, and formed a palatable 
dish. When this change was made in the menu mutton soup was 
served on Saturday instead of Friday, as at other seasons. 

The bread baked at the institution was excellent in quality, an ex- 
perienced baker being in charge of this department. The bread 
served to the inmates was made of a mixed spring and winter wheat 
flour. This yielded a loaf which, though not absolutely white in 
color, was light, tender, and of excellent flavor, with a crust nicely 
browned but not too thick. The bread was practically uniform in 
quality. These characteristics, always desirable, are essential when, 
as at Bayview and many other institutions, bread forms the basis of 
the diet. 

During the green- vegetable season two kinds were served on Sun- 
days. Throughout the summer corn, peas, etc., were added to the 
soup when they could be obtained from the farm. Radishes and 
onion tops were served to the various dining rooms in season, gener- 
ally for supper, and were much relished. Vinegar was allowed the 
inmates on days when bacon, cabbage, or greens were served. Salt 
was always placed on the tables, but pepper was generally added in 
the kitchen to the articles which required it. So far as could be as- 
certained, the inmates received no desserts of any sort except on cer- 
tain holidays, when a complete change was made in the dinner menu. 

The women inmates drank a good deal of tea, but on the whole 
coffee was the beverage of the institution. The latter was served 
twice a day, namely, at breakfast and at supper, and was made from 
a combination of Rio coffee and roasted rye, a mixture not uncom- 
mon in many homes in the locality. Sugar and milk were not placed 
on the tables, but Avere added to the coffee when it was made. This 
method, while it appeared to be the only one practicable, had the dis- 
advantage of not suiting the individual preferences regarding the 



21 

quantity of sugar and milk. It was learned that an attempt was once 
made to put sugar on the table and let the men help themselves, but 
this was found impracticable. It would seem that in such an insti- 
tution arrangements might be made whereby one person at each table 
might have charge of the milk and sugar and give each one at the ta- 
ble the amounts which suited his taste. Otherwise, the coffee seemed 
to be fairly satisfactory. The amount of milk used in it was greater 
or less according to the season, as the institution depends upon its 
own herd of cows for its milk supply. At the time of these studies 
(spring, 1905) about 8 gallons of milk were used in making up ap- 
proximately 150 gallons of coffee. The amount of sugar used for 
this quantity was about 38 pounds. 

Bread was the only article of food supplied in absolutely unlimited 
quantities to every person. Nevertheless, the aim was to provide 
enough of other foods so that there should be plenty for second or 
even third helpings for all who desired them. 

In apportioning the soup and coffee to the different departments, 
the cook served what he considered sufficient amounts, measuring the 
quantities with his dippers, which he knew held a certain number of 
rations. The quantities served were in accordance with the number 
of people in each department, with an allowance, based on experience, 
for extra helpings. Similarly, the meat served on Mondays and 
Thursdays was cut up into rations and these rations counted out and 
apportioned according to the number of persons, some allowance being 
made for extra helpings. The cook's judgment in this matter was 
very good. There were very seldom calls at the kitchen for extra sup- 
plies, and, on the other hand, the amounts left over were very small. 

The diet throughout the summer was varied by the use of different 
vegetables in their season. One practice at Bayview, namely, the 
method of distributing radishes, green onions, etc., was interesting, in- 
asmuch as it is not customary, or at least it was not followed at other 
institutions in which dietary studies have been made under the aus- 
pices of this Office. If there were not enough vegetables at any one 
time to supply the whole institution, the supply first at hand was 
given, say, to the women's dining room, then the next lot to the men's 
dining room, and so on in rotation. In some institutions an article, 
even if it grows in the institution garden, is not commonly used un- 
less there is enough to serve the whole institution at the same time. 

MENUS FOR THE DIFFERENT WARDS. 

The four dietary studies made at Bayview included by no means 
all the different classes of inmates. It is of interest, therefore, to give 
some data regarding the general menus, to show both the kinds of 
food used and the variations in the rations of different wards of the 
institution. These menus were of necessity very simple, and since 



22 

they were made at a time of the year when there was little variety in 
the vegetables available, indicate a simpler diet than was really 
served, taking the year through. It should also be remembered that 
at Bayview, as in most institutions, the Sunday and holiday meals 
varied from those of other days. On Sunday soup was not served, 
but meat (generally salt smoked pork or shoulder) and vegetables 
were provided, and on regular holidays, special dinners. Thus on 
Thanksgiving turkeys are served, and on Christmas, New Year's, and 
Fourth of July, special menus are provided. 

A menu, selected as a fair sample of those served in the insane 
department, follows: 

Sample Menu of Insane Department. 

Breakfast: Bread, coffee. 

Dinner: Beef soup a with vegetables, bread, rice. 

Supper: Bread, stewed fruit, coffee. 

A sample menu for the hospital ward follows : 

Sample Menu of Hospital Ward. 

Breakfast: Oatmeal, milk, bread, butter, eggs, tea, and coffee. 

Dinner : Chicken soup, beefsteak, bread, tea. 

Supper : Bread, butter, crackers, milk, tea, and coffee. 

The menus for the phthisical ward and for the chronic patients 
were of the same general character. 
A sample menu for the infirmary ward or " general diet " follows : 

Sample Menu for Infirmary (or General Diet). 

Breakfast: Oatmeal, milk, bread, butter, eggs, tea, and coffee. 
Dinner: Beef soup with vegetables, bread. 
Supper: Bread, coffee. 

The character of meals served the working women is shown by the 
following sample menu: 

Sample Menu for Working Women. 

Breakfast : Oatmeal, milk, Hamburg steak, bread, butter, tea, and coffee. 
Dinner: Bacon, beef soup with vegetables, rice, milk, bread. 
Supper: Bread, butter, tea, and coffee. 

The farm and stable helpers received the infirmary diet, together 
with a sort of meat and vegetable stew, called " hash," for breakfast 
each morning, cold beef for supper each evening, and molasses Tues- 
day evening at supper. 

According to these menus the diet of the department for the insane 
appears to have been more varied than that of any other departments 
of Bayview excepting the hospital wards. Many of the inmates were 

° See p. 19. 



23 

physically vigorous, and the Bayview officials evidently shared the 
belief commonly held that the insane need a fairly generous diet. 
The diet in the insane ward did not differ very much from hospital 
diets of public insane hospitals, as reported in previous studies made 
under the auspices of this Department a and similar work. 6 Rice and 
oatmeal were used extensively, both being well cooked. In the hos- 
pital ward the diet was naturally quite different from that in either 
the insane wards or the wards for regular inmates, being fitted to 
the needs of the individual patients. Eggs and milk were, of course, 
much used there. 

There is no question that the diet supplied the regular population 
(with the exception of the hospital wards) was less varied than that 
of many hospitals for the insane. It is interesting to note in this 
connection that when inmates were first received they were, as a rule, 
satisfied with the food, but after a time they did not relish it so much. 
This was very likely due, in large measure, to the monotony of the 
diet. 

Apparently the menu as a whole was as good as was possible with 
the amount of money available ; and if the institution authorities are 
to provide a more varied diet more money will be required. If more 
money could be allowed for the purpose the diet could be easily and 
materially improved. There are a number of inexpensive dishes 
which are commonly used in insane hospitals which could be sug- 
gested for use here and which, introduced at least one day in a month, 
would make a comparatively small increase in the cost per year to 
the asylum. Such changes are, for example, the addition of baked 
beans to the regular supper menu once each month. Ginger cake 
might also be used for supper once a month, along with the regular 
bread and coffee, and would give a pleasing variety to the diet, par- 
ticularly as nothing in the nature of a dessert is served except on hol- 
idays. Baked chopped hash would be a new and inexpensive dish 
that might readily be supplied. It would seem, too, that potatoes 
should be served with fish, as that accords with the custom in this 
country. While the bread served is very good, the occasional use of 
rolls or biscuits would vary the diet and make very little difference 
in cost. Frankfort sausages would also give a pleasing variety. 
Macaroni, prepared with tomatoes or cheese, would make a very pal- 
atable and nutritious dish at a very small cost. It is altogether prob- 
able that some such small additions to the menu would be of value 
as a source of greater contentment, even though they were not abso- 
lutely needed for nourishment. 

a U. S. Dept. Agr., Office Expt. Stas. Bui. 150. 

6 N. Y. State Com. Lunacy Ann. Rpt, 11 (1898-9); 12 (1899-1900); 13 
(1900-1). ' 



24 

METHODS OF MAKING THE DIETARY STUDIES. 

The weights of foods served, returned, and wasted during these 
studies were recorded in the usual way ; the methods of cooking were 
noted; the composition of the different foods was determined as de- 
scribed on page 15 ; and the number of persons served in the dining 
rooms under consideration was noted for each meal. From these 
data has been deduced the nutritive value of food served, eaten, and 
wasted per man or per woman per day, as shown in the tables beyond. 
Observations of general conditions were also made as an aid to in- 
terpreting the data. 

One variation from the usual custom has been made in presenting 
the results of the investigation. It has been usual to record the 
amounts of nutrients and energy per man per day. In these studies, 
however, only the figures for protein and energy are given, these con- 
stituting the essential data for considering the nutritive value of the 
ration and related questions. The tables, therefore, do not show the 
relation of fats and carbohydrates to the diet. While such data 
might be interesting, they are not essential, since in the ordinary 
mixed diet it may be safely assumed that fats and carbohydrates 
will appear in reasonable proportions, and, furthermore, on theoret- 
ical grounds, it is immaterial, at least within limits not exceeded in 
these diets, which of these classes of foods supplies the energy, pro- 
vided the total quantity is sufficient. 

DIETARY STUDIES NOS. 682 AND 683, MEN'S DINING ROOM, REGU- 
LAR PATIENTS AND STABLE HANDS AND CHRONIC AND SPECIAL 
DIET PATIENTS. 

Dietary studies Nos. 682 and 683 were carried on simultaneously 
in the men's dining room, which is the largest in the institution and 
in which several classes of persons are served. The total number 
served at the time the studies were made included 16 farm and 
stable helpers, 135 regular inmates, 82 chronic patients, and 24 men 
on special diet. In the winter the number served in the dining room 
is considerably larger. Study No. 682 included the regular patients 
and the stable hands and No. 683 the chronic and special diet 
patients. 

During the week covered by these studies the chronic population 
included in study No. 683 did not vary from day to day. There was 
a very marked decrease, however, in the number supplied with the 
regular diet and included in study No. 682, the exact number for 
each day of the week covered by the study being as follows : Monday, 
144; Tuesday, 143; Wednesday, 140; Thursday, 136; Friday, 132; 
Saturday, 128, and Sunday, 127. 

The majority of inmates in this dining room were classed as work- 
ers, though the amount of work they did was, of course, very variable. 



25 

It has been stated above that the population of Bayview was composed 
almost entirely of men and women ranging from middle life to old 
age. In this dining room the so-called chronic patients were almost 
all elderly and decrepit, while the large majority of the regular in- 
mates were men in middle life or older. The officer in charge of 
this dining room (himself an inmate of the institution) gave it as 
his opinion that the number of men under 50 years of age constituted 
a very small fraction of the total number. 

The dining room was well cared for and clean. The food was 
served on bare, unpolished wooden tables, which were frequently 
washed and scrubbed with great care. The menu for the regular, 
chronic, and special diet patients was principally the same, but the 
chronic patients were supplied, in addition, with some articles which 
the regular inmates did not receive, and the special-diet patients had 
extra articles on order of the physician in charge. The farm and 
stable helpers had somewhat different food from the other inmates 
of this dining room, being allowed meat three times a day and potatoes 
with dinner on several days of the week. The meat and potatoes 
were frequently served together in a dish called " hash," though it 
was really a beef stew. Soup and coffee were served in tin cups, 
crockery plates being provided for other food. The ration system 
was followed entirely in this dining room except in the case of bread, 
that is, each man's share of the different kinds of food was served 
to him from the large lots sent from the kitchen and put at his place 
at the table. Bread was sliced and placed in square tin pans, three 
or four to a table, so that each man might help himself. 

Meals were served as follows: Breakfast at 6 a. m., dinner at 12 m., 
and supper at 5.50 p. m. In the winter season there was not room 
for all the men to eat at the same time; the chronic patients were 
therefore served about twenty minutes earlier than the others and 
finished in time to let all the regular patients sit down together. In 
general no attempt was made to keep separate the amount of bread 
served to each person or the amounts of individual waste. The 
waste bread from the chronic patients was, however, kept separate 
for the different meals of one day, and the amount weighed. This, 
it is believed, gave a very fair idea of the average waste of bread 
from this department, as there appeared to be little variation in the 
amount from day to day. The results of the study with regular 
patients and stable hands are summarized in the table which follows, 
and show the amounts of protein and energy in food eaten and 
wasted for seven consecutive days of three meals each, the results 
being given separately for each day of the week. This method of 
tabulating the data gives an opportunity to observe the variation in 
food consumption on different days. 



26 



Amounts of protein and energy in food eaten and wasted per man per day, 

dietary study No. 682. 





Amounts eaten. 


Amounts wasted. 




Protein. 


Energy. 


Protein. 


Energy. 


SUPPER, MAY 7, TO DINNER, MAY 8. 

Animal food: 

Beef, roasted (18) " ^ 


Grams. 
3 
41 
2 


Calories. 

21 

381 

31 


Grams. 


Catories. 


Beef boiled (1) . . 






Milk (33) 














46 


433 












Vegetable food: 

Bread (4) 


55 


1,273 
97 
33 
222 


4 


103 


Sugar (46). ' 




Potatoes (baked) (64) " 


1 
1 










12 










57 


1,625 


4 


115 






Miscellaneous food: 

Soup (6) 


17 
5 


522 
72 


1 


20 


Hash (80) b, . 


6 




1 


8 












22 


594 


2 


34 








125 


2,652 


6 


149 






SUPPER, MAY 8, TO DINNER, MAY 9. 

Animal food: 

Pork, shoulder, boiled (23) 


23 

2 


424 
32 






Milk (33) 














25 


456 












Vegetable food: 

Bread (4) 


66 


1.527 
100 


3 


74 


Sugar (46) 














66 


1,627 


3 


74 






Miscellaneous food: 

Soup (15) 


36 
6 


561 
91 




4 


Hash (80) b 




2 




1 


7 










42 


652 


1 


13 






Total food for 3 meals 


133 


2,735 


4 


87 






SUPPER, MAY 9, TO DINNER, MAY 10. 

Animal food: 

Beef, roasted (19)". 


4 
22 
2 


55 
406 
33 






Pork, shoulder, boiled (23) 






Milk (33) 














28 


494 












Vegetable food: 

Bread (4) . 


64 


1,481 

102 

17 


3 


79 


Sugar (46).. * 




Radishes (68) 


1 














65 


1,600 


3 


• 79 






Miscellaneous food: 

Soup (15) 


39 
5 


608 
80 






Hash (80) b 














44 


' 688 














137 


2,782 


3 


79 






SUPPER, MAY 10, TO DINNER, MAY 11. 

Animal food: 

Beef, boiled (1)... 


41 
9 


377 
117 
345 
34 







Beef, roasted (19) a 












Milk (33) 














70 


873 









a Served only to farm and stable helpers. 

b This was a thick stew of potatoes and meat. It was served only to farm and stable helpers. 



27 



Amounts of protein and energy in food eaten and wasted per man per day, 
dietary study No. 682 — Continued. « 



Food materials. 


Amounts eaten. 


Amounts wasted. 


Protein. 


Energy. 


Protein. 


Energy. 


supper, may 10, to dinner, may 11— continued. 

Vegetable food: 

Bread (4) 


Grams. 
67 


Calories. 

1,544 

96 

29 


Grams. 
3 


Calories. 

72 


Sugar (46) ' 






•1 














68 


1,669 


3 


72 






Miscellaneous food: 


19 
6 


514 

87 






Hash (80) b 








1 


6 












25 


601 


1 


6 








163 


3,143 


4 


78 






SUPPER, MAY 11, TO DINNER, MAY 12. 

Animal food: 

Pork shoulder boiled (23) 


19 
68 
2 


359 

969 

40 












Milk (33) 














89 


1,368 












Vegetable food: 

Bread (4) 


74 


1,707 
155 


3 


70 


Sugar (46) 














74 
6 


1 , 8t : 2 
87 


3 


70 




5 










169 


3,317 


3 


75 






Animal food: 

Butter (31) a 




34 
54 






Milk (33) 


2 














2 


88 












Vegetable food: 

Bread (4) 


69 


1,585 
101 

28 


4 


92 


Sugar (46) 




Radishes (68) 


1 














70 


1,714 


4 


92 






Miscellaneous food: 

Soup (7) . 


51 
6 


523 

87 






Hash (80) b . . 














57 


610 












Total food for 3 meals 


129 


2,412 


4 


92 






SUPPER, MAY 13, TO DINNER, MAY 14. 

Animal food: 


4 

52 

2 


54 

963 

34 






Pork, shoulder, boiled (23) 






Milk (33) 














58 


1,051 












Vegetable food: 

Bread (4) 


70 


1,611 
103 
282 
139 


5 


119 


Sugar (46) 






12 
4 






Potatoes, boiled (66) 














86 
5 


2,135 
80 


5 


119 














149' 


3,266 


5 


119 








144 


2,901 


I « 


97 







a Served only to farm and stable helpers. 

b This was a thick stew of potatoes and. meat. It was served only to farm and stable helpers. 



28 

The data given in the above table for dietary No. 682 show very 
clearly that there is a decided difference in the amount of nourish- 
ment received from day to day by the average subject, the quantities 
for individual days ranging from 125 grams to 169 grams of protein 
and from 2,412 to 3,317 calories of energy. The average for the 
seven days was 144 grams protein and 2,901 calories of energy per 
day. These figures are rather noticeable, since they show a some- 
what narrower nutritive ratio than has usually been found in the 
dietary studies made under the auspices of the Office of Experiment 
Stations, a i. e., the proportion of protein to the energy is quite large. 
As is discussed in some detail elsewhere (p. 40), the subjects of this 
study were apparently well nourished. It seemed to the observer 
that in these studies the amounts of food consumed by different indi- 
viduals varied greatly. Some inmates really consumed very little, 
while others were hearty eaters. This means that the individual 
consumption varied more from the average than in studies previously 
reported. 

The amount of waste in study No. 682 was nearly uniform for each 
day of the study, and the daily average, 4 grams protein and 97 
calories of energy — only 3 per cent of the total amounts supplied— 
is remarkably small not only for institution but even for family 
dietaries. The reason for such a small amount of wasted food is 
discussed on page 36. One point which should be noted in this and 
the following dietary studies is that the soup wasted was in many 
cases wholly or in part of different composition from that consumed, 
because the inmates ate nearly all the solid matter of the soup and 
left the broth. When both soup and soup broth remained the total 
waste was weighed and the proportion of broth estimated. A sample 
of this waste broth was analyzed and its percentage composition used 
for computing the nutritive value of all the waste broths. While 
this method is not strictly accurate, it is the only one which seemed 
practicable and is certainly much more accurate than to assume that 
the waste had the higher composition of the thick soup served. 
These waste portions of the soup had but little nutritive value, being 
largely fluid. 

The general conditions under which dietary study No. 683 with 
chronic patients and those on a special diet, served -in the men's 
dining room, was made, were spoken of in connection with dietary 
study No. 682, the two studies, as has been said, being carried on at 
the same time. The results of the study are summarized in the table 
which follows. 

a See U. S. Dept. Agr. Office Expt. Stas. Cir. 89. 



29 



Amounts of protein and energy in food eaten and wasted per man per day, 

dietary study No. 683. 



Food materials. 


Amounts eaten. 


Amounts 


wasted. 


Protein. 


Energy. 


Protein. 


Energy. 


SUPPER, MAY 7, TO DINNER, MAY 8. 

Animal food: 


Grams. 
41 
2 


Calories. 
553 
24 
158 
188 


Grams. 


Calories. 


Eggs boiled (30) 






Butter (31) 






Milk (33) 


9 














52 


923 












Vegetable food: 

Oatmeal boiled (2) 


5 
24 


139 
562 
98 






Bread (4) 


2 


38 


Sugar (46) 














29 


799 


2 


38 






Miscellaneous food: 


18 


521 


1 


18 




5 














18 


521 


1 


23 








99 


2,243 


3 


61 






SUPPER, MAY 8, TO DINNER, MAY 9. 

Animal food: 

Eggs (30) 

Butter (31) 




25 
158 
185 












9 














11 


368 













Vegetable food: 


4 

3 

26 


130 
168 

587 
100 






Rice, boiled (3) 






Bread (4) 


2 


38 


Sugar (46) 














33 


985 


2 


38 






Soup (15) . 


35 


556 


1 


10 




6 












Total miscellaneous food b 


35 


556 


1 


16 






Total food for 3 meals 


79 


1,909 


3 


54 






SUPPER, MAY 9, TO DINNER, MAY 10. 

Animal food: 

Eggs (30) 


2 


25 
158 
198 






Butter (31) 






Milk (33) 


10 












Total animal food 


12 


381 












Vegetable food: 

Oatmeal, boiled (2) 


5 


139 
100 
587 
18 
140 






Sugar (46) 






Bread (4) 


25 

1 
1 


2 


38 


Radishes (68) 




Sauce from evaporated apples (14) 












Total vegetable food _ 


32 


984 


* 


38 


Miscellaneous food: Soup (15) 


31 


497 













Total food for 3 meals c 


75 


1,862 


2 


38 






SUPPER, MAY 10, TO DINNER, MAY 11. 

Animal food: 

Beef, boiled, with gravy (17) 


42 
2 


554 
25 
158 
197 






Eggs (30) 






Butter (31) 






Milk (33) 


9 












Total animal food 


53 


934 













a Of this, 7 grams of protein and 150 calories of energy were served to special-diet patients only. 
b Of this, 8 grams of protein and 156 calories of energy were served to special-diet patients only, 
c Of this, 8 grams of protein and 161 calories of energy were served to special-diet patients only. 



30 



Amounts of protein and energy in food eaten and wasted per man per day, 
dietary study No. 683 — Continued. 



Food materials. 


Amounts eaten. 


Amounts wasted. 


Protein. 


Energy. 


Protein. 


Energy. 


SUPPER, MAY 10, TO DINNER, MAY 11— continued. 

Vegetable food: 

Oatmeal, boiled (2) 


Grams. 
5 
25 


Calories. 

141 

584 

98 


Grams. 


Calories. 


Bread (4) 


1 


41 


Sugar (46) 












Total vegetable food 


30 


823 


1 


41 






Miscellaneous food: 

Soup (15) 


34 


532 






Broth from soup (11) : 


1 


8 












34 


532 


1 


8 






Total food for 3 meals «. 


117 


2,289 


2 


49 






SUPPER, MAY 11, TO DINNER, MAY 12. 

Animal food: 

Herring, baked (28) 


70 
2 
10 


939 
25 
198 
158 






Eggs (30) 






Milk (33)..' 






Butter (31) 














Total animal food 


. 82 


1,320 












Vegetable food: 

Oatmeal, boiled (2) 


5 
3 
25 


139 
174 
587 
155 






Rice, boiled (3) 






Bread (4) 


2 


37 


Sugar (46) 












Total vegetable food . 


33 


1,055 


2 


37 






Total food for 3 meals b 


115 


2,375 


2 


37 






SUPPER, MAY 12 TO DINNER, MAY 13. 

Animal food: 

Eggs (30) 


2 


25 
158 
209 






Butter (31) 






Milk (33) 


10 












Total animal food 


12 


392 












Vegetable food: 

Oatmeal, boiled (2) 


5 

25 


138 
587 
100 

28 
143 






Bread (4) 


2 


38 


Sugar (46) 




Radishes (68) 


1 

1 






Sauce from evaporated apples (14) 












Total vegetable food 


32 


996 


2 


38 






Miscellaneous food: Soup (7) 


38 


383 












Total food for 3 meals c. 


82 


1,771 


2 


38 






SUPPER, MAY 13, TO DINNER, MAY 14. 

Animal food: 

Pork , shoulder, boiled (23) 


27 

2 


485 
25 
158 
150 






Eggs (30) 






Butter (31) 






Milk (33) 


7 












Total animal food 


36 


818 












Vegetable food: 

Oatmeal, boiled (2) 


4 
25 


131 
587 
103 
382 
61 






Bread (4) 


2 


37 


Sugar (46) 




Cabbage sprouts, boiled (5) 


17 
2 






Potatoes, boiled (65) 












Total vegetable food 


48 


1,264 


2 


37 








84 


2,082 


2 


37 








93 


2,076 


2 


45 







a Of this, 7 grams of protein and 159 
b Of this, 8 grams of protein and 167 
c Of this, 8 grams of protein and 172 
d Of this, 5 grams of protein and 106 
e Of this, 7 grams of protein and 153 



calories of energy were served to special-diet patients only, 
calories of energy were served to special-diet patients only, 
calories of energy were served to special-diet patients only, 
calories of energy were served to special-diet patients only, 
calories of energy were served to special-diet patients only. 



31 

The figures recorded in the table for food eaten and wasted by the 
chronic inmates present a striking contrast to those in the table on 
page 27, though all these subjects received their meals in the same 
dining room. The amount of protein in the ration of the chronic and 
special diet patients varied from 75 to 117 grams, and the energy from 
1,771 to 2,375 calories per man per day, the average for the seven days 
covered by the study being 93 grams protein and 2,076 calories energy. 
These amounts are very much smaller than was the case with the reg- 
ular patients in dietary study No. 682, the energy value being espe- 
cially low. 

The amount of waste in this study, as in the preceding, was ex- 
tremely small, the average for the week being but 2 grams protein and 
45 calories energy per day, or 2 per cent of the total amount of each 
supplied. These figures, like those in the preceding study, are very 
small and will be discussed beyond (see p. 35). 

DIETARY STUDY NO. 684, WOMEN'S DINING ROOM. 

Dietary study No. 684 was made in the women's dining room with 
110 women, on an average, and 3 men who also had their meals there. 
Of the total number of subjects only about 55 were classed as workers, 
though nearly all did more or less work. A large number of the 
women were elderly; in fact, the majority had passed middle life and 
some were very old. The ration system (see p. 25) was followed in 
this as in the men's dining room. Part of the food served was cooked 
in the " county kitchen " and part in the " diet kitchen," while some 
of the extra allowance of meat for the workers was supplied from the 
officers' kitchen. It was not found practicable to obtain the weights 
of the food of the working women as distinguished from that of the 
others, so the weighings were made for the whole group. It is be- 
lieved, however, that this does not introduce any great error in the 
final results, as certainly over half of the group were workers and 
the amount of extra food did not constitute a very large proportion 
of the total diet. 

The dining room was similar in all essentials to that in the men's 
ward, as was also the service. 

The data showing the amount of protein and energy in eaten and 
wasted food in the women's dining room during the week covered by 
the study are shown in the following table, the quantities being 
expressed on the basis " per woman per day." In computing the 
results the food of the 3 men was considered equivalent to that of 
4 women. 



Amounts of protein and energy in food eaten and wasted per woman per day. 

dietary study No. 



Food mate: 


Amounts eaten. 


Amounts wasted. 


Protein. 


Energy. 


Protein E 


STTPPEB. MAY 14. TO DDsXXE. MAT 15. 

Animal food: 

Beef, boiled (1 | 


Grains. 

■ 


Calories. 

257 

19 

112 

: - 


Grams. 


Calories. 


~r;; 






BuTTcr ; 1 








12 









Tot^I animal food . . 


e 


55 








Vegetable food: 

— p -'■-". ; 


: 

33 


- 
745 
131 










S agar 4- : 










Total vegetable food 


: : 


946 


6 :-; 


Miscellaneous food: 

b -='- a 


_ 
4 


128 




;-:.-.— : 

Souj B 


i u 












14 


|2| 


- 






Total food for 3 meals ■ 


91 


: 


7 


SrPPEE MAY 15. TO mWWKK, HAT 1 

Animal food: 

Ha~" , - 


! 


19 
286 






EggS JO) 




Butt rr 31 




Milk - 




13 










28 


f71 








able food: 

">i — ;■:," \- ". f- 


2 


31 
734 
127 

39 


4 


Rice, boiled (3) 


1 25 


Sread 


;: 


138 






- - 


: 










- :: 


?y: 


_ 






Mis; ellaneo-as :'; : : 

VJ - 




319 






:: 




Broth from soup - 


1 15 










Total miscellaneous food 


2-: 




: is 


ratal food for 3 mess i 


so 


1.803 


182 


sttp"? :: ,.": If ronnra i 

..:::::::: ;'; : :1: 

Pork, shoulder, trailed I . 


11 

2 


194 
IS 

:;s 

;■ 




Ecrs S 




Butter (31 




v::-' --- 


12 








Total animal fond - 


- r 


■■-: 








Vegetable food: 

; : 


9 

3i 






m 




- 




- ; - 










?•; 


; : 


96 






Miscellaneous food: 


14 










1 13 












14 


. 


1 " : 






:-:a! :';■; i :';: : r --Is - 


7.5 




" 









of protein and 5S calories ; :' e n e : g 

.:: i-ii ;" ;/. 



• 

special- ii:: pirlezTS :—j. 



33 



Amounts of protein and energy in food eaten and ivasted per woman per day, 
dietary study No. 684 — Continued. 



Food materials. 


Amounts eaten. 


Amounts wasted. 


Protein. 


Energy. 


Protein. 


Energy. 


SUPPER, MAY 17, TO DINNER, MAY 18. 

Animal food: 


Grams. 
48 
8 
2 


Calories. 
643 
148 
18 
108 
255 


Grams. 


Calories. 








Epps f 301 












Milk (33) 


12 














70 


1,172 












Vegetable food: 


2 

34 


61 
787 
126 
57 
60 




6 




3 


78 








1 

1 




















38 


1,091 


3 


84 






Miscellaneous food: 


15 


241 








1 


16 












15 


241 


1 


16 








123 


2,504 


4 


100 






SUPPER, MAY 18, TO DINNER, MAY 19. 

Herring "baked (28) 


11 
2 


164 

18 

108 

260 












Butter (31 ) 






Milk (33) 


13 














26 


550 












Vegetable food: 


2 

1 

32 


68 
38 
750 
126 






Rice boiled (3) 






Bread (4) 


5 


114 
















35 


982 


5 


114 






Soup (15) 


16 


253 








1 


17 












16 


253 


1 


17 






Total food for 3 meals a 


77 


1,785 


6 


131 






SUPPER, MAY 19, TO DINNER, MAY 20. 

Animal food: 

Eggs (30) 


2 


19 
108 
250 






Butter (31) 






Milk (33) 


12 














14 


377 












Vegetable food: 

Oatmeal, boiled (2) 


2 
34 


68 
775 
126 

40 






Bread (4) 


4 


89 


Sugar (46) 




Radishes (68) 


2 












Total vegetable food 


38 


1,009 


4 


89 






Miscellaneous food: 

Soup (15) 


14 
8 


233 
124 






Hash (80) 






Broth from soup (11) 


1 


14 










Total miscellaneous food 


22 


357 


1 


14 






Total food for 3 meals & 


74 


1,743 


5 


103 







a Of this, 4 grams of protein and 56 calories of energy were served to special-diet patients only. 
& Of this, 4 grams of protein and 55 calories of energy were served to special-diet patients only. 

16553— Bull. 223—10- — 3 



34 

Amounts of protein and energy in food eaten and wasted per woman per day, 
dietary study No. 684 — Continued. 



Food materials. 


Amounts eaten. 


Amounts wasted. 




Protein. 


Energy. 


Protein. 


Energy. 


SUPPER, MAY 20, TO DINNER, MAY 21. 

Animal food: 

Pork, shoulder, boiled (23) 


Grams. 

16 

1 


Calories. 

293 

19 

147 

265 


Grams. 


Calories. 


Eggs (30) 






Butter (31) 






Milk (33) 


13 












Total animal food 


30 


724 












Vegetable food: 

Oatmeal, boiled (2)... 


2 
34 

8 


53 
782 
178 
128 

61 






Bread (4) 


4 
2 


98 


Cabbage sprouts (5) 


54 


Sugar (46) 




Sauce from evaporated apples (14) 
















Total vegetable food 


44 


1,202 


6 


152 






Total food for 3 meals «... . 


74 


1,926 


6 


152 








85 


1,924 


6 


134 







a Of this, 4 grams of protein and 57 calories of energy were served to special-diet patients only. 

The data given in the table above show that the variations in the 
amounts of food consumed on different days of the week were con- 
siderable, as was the case in the two preceding studies. The average 
amounts eaten per woman per day, 85 grams protein and 1,924 
calories of energy, are equivalent to 106 grams protein and 2,405 
calories of energy when calculated on the basis per man per day 
(the daily food requirement of a woman being taken as 0.8 that of a 
man). That this ration furnished sufficient protein there can be 
but little question. The amount of energy furnished is, however, not 
proportionately high. Whether or not the amount was sufficient is 
discussed later (p. 40). 

The 6 grams of protein and 134 calories of energy in the waste 
represent about 7 per cent of the total food served. This amount, 
though relatively larger than that noted in the other studies at Bay- 
view, was small as compared with that in other institutions studied. 

DIETARY STUDY NO. 685, MEN'S RECEIVING WARD. 

Study No. 685 was made with 82 men in the men's receiving ward, 
which is located in the half basement of the main building. It is 
in this ward that the men are placed on coming into the institution. 
Some of the men included in this group were epileptics, some cripples, 
and some men in good health. There were a few young men, but 
most had reached middle age and some were aged. Judged by the 
amounts of food which were sent to this ward, these men on an aver- 
age were hearty eaters, though very few of them appeared to be 
strong and healthy. Only 8 of the group were classed as workers. 



35 



The men in this dining room had their breakfast early, being through 
the meal by 6 in the morning. They had their dinner about 12 and 
their supper a little before 6 o'clock p. m. 

The dining room and service did not differ in any important par- 
ticular from those previously described. 

The amounts of protein and energy consumed and wasted during 
the study are shown in the following table, the data being recorded 
for the entire period and not for the individual days, as was the case 
in studies Nos. 682, 683, and 684. 

Amounts of protein and energy eaten and toasted, per man per day, dietary 

study No. 685. 



Food materials. 


Amounts eaten. 


Amounts wasted. 


Protein. 


Energy. 


Protein. Energy. 


Animal food: 

Beef, boiled (1) 


Grams. 
11 
4 


Calories. 
103 
71 
36 
80 


Grams. 


Calorics. 








Butter (31) 






Milk (33) 


4 














19 


290 












Vegetable food: 

Bread (4) 


54 


1,234 

99 

69 

9 

20 




3 


Sugar (46) 








3 












Sauce from evaporated apples (14) 












Total vegetable food 


57 


1,431 




3 








Miscellaneous food: 

Soup (15) 


35 


553 


1 


6 


Broth from soup (11) • 


2 












35 


553 


1 


8 






Total food a 


111 


2,274 


1 


11 



a Of this, 3 grams of protein and 76 calories of energy were served to special-diet patients only. 

The results of this study show an average consumption of 111 
grams protein and 2,274 calories of energy per man per day. The 
waste was less than 1 per cent of the food served, an extremely small 
proportion. In fact, it was so small that it was scarcely worth taking 
account of. It should also be noted that no food was returned to 
the kitchen. Usually all the food sent was eaten, but if any food 
was not served it was saved in the dining room for the next meal, or 
was eaten between meals. 

WASTE. 

The average amounts of waste for the three studies with men were 
about 2 per cent only of the average amount served, much less than 
is to be expected in institutions of this kind. Judging from the 
available data on this subject, one may fairly consider any waste 
under 8 or 10 per cent of the food served to be small. It would, there- 



36 

fore, seem that the management had decreased these amounts as much 
as possible without danger of undersupplying the inmates. The 
waste in the women's dining room, though somewhat larger than the 
average for the three studies with men, was still remarkably small. 

The small amounts of waste may be due either to a lack of sufficient 
quantities of food, which tends to make the subjects consume all that 
is available for them, or to care on the part of the institution authori- 
ties in planning the quantities necessary so closely that all may 
have a sufficiency and yet nothing be wasted. In this connection it 
should be noted that the diet was peculiar in that the food served was 
of such a nature that it did not allow of much waste, unless the quan- 
tities served should be too great. Thus the meat which was served had 
all the bones removed before being sent to the tables, so that there 
was no loss from meat adhering to bones, while the bread which was 
not used could easily be returned for another meal (except such as was 
placed upon the individual plates). That the management had 
planned the diet with a view to avoiding waste was evident from the 
nature of the foods served, and, as has already been stated, it was 
apportioned to the several dining rooms with exceptional care and 
good judgment. That the subjects in study No. 682 had sufficient 
food can not be questioned, yet in this study the waste is as small as 
with the others. This would seem to show pretty conclusively that 
the very small waste was due to care in the selection and preparation 
of food on the part of the officials of the institution. Such a condition 
of affairs is eminently desirable in public institutions and speaks most 
highly for the management. 

AMOUNT EATEN PER PERSON AS SHOWN BY TOTAL AMOUNTS 

PURCHASED. 

As a means of learning more regarding the amount of food actually 
consumed in different dining rooms in the institution, it was thought 
best to estimate the quantity of nutrients and energy of the diet from 
the kind and amounts of food purchased for the inmates. To this 
end recourse was had to the books of the institution, and a table has 
been prepared showing the amounts of food annually purchased for 
the use of the inmates, and also the amount of farm products raised 
at Bay view for home consumption. From the data thus obtained, 
showing the total amount of food provided, the protein, fat, and 
carbohydrates supplied were calculated, as well as the average amount 
obtained per person per day. The data thus obtained form prac- 
tically a dietary study for a year for all the inmates. Such data 
are especially useful where regular detailed studies of a large part of 
the population are not made, as was the case at Bayview, because they 
give some idea as to the average food consumption of all the inmates 
of the institution throughout the year. The data are summarized in 
the table following. 



37 



Food provided for inmates during entire year, and nutrients contained in it. 



Food materials. 



Total weight. 



Protein. 



Fat. 



Carbo- 
hydrates. 



ANIMAL FOOD. 

Meats and fish: 

Beef, fore quarter, lean 

Mutton, side 

Pork, side, not including lard 
and kidney 

Bacon, shoulder, smoked, me- 
dium fat 

Sausage 

Poultry 

Herring, fresh and salt 

Eggs 

Dairy products: 

Butter 

Cheese 

Milk 

Lard 

VEGETABLE FOOD. 

Cereals: 

Wheat flour, spring and winter 
wheat 

Hominy 

Oats, rolled 

Rice 

Rice flour 

Crackers, soda 

Crackers, water 

Cakes, mixed 

Ginger snaps 

Sugars: 

Candy 

Molasses 

Sugar 

Vegetables: 

Beans, pea, dried 

Beans, Lima, dried 

Beans, Lima, fresh 

Beans, string 

Beets 



Carrots. 

Cauliflower 

Celery 

Corn 

Lettuce 

Onions 

Onion tops , spring onions . 

Parsley 

Parsnips 

Peas, green 

Potatoes 

Radishes 

Ruta- 

Salsify . 

Sauerkraut. .... 

Spinach 

Squash 

Tomatoes 

Turnips 

Fruits: 

Apples 

Apples, dried. . 

Peaches, dried. 

Prunes, dried.. 
Miscellaneous: 

Coffee, Rio 

Rye (for coffee) . 



Pounds. 

207, 109 

26,000 

5,794 

46,072 
2,300 
2,148 
4,900 

25,358 

13,759 

3,867 

260,018 

800 



362, 208 

1,100 

6,048 

11,933 

196 

2,043 

3,633 

714 

2,027 



10,212 
29,651 

3,758 

425 

3,276 

4,472 

2,711 

32,451 

8,921 

922 

900 

10,481 

378 

3,258 

878 

72 

10,206 

1,188 

133,688 

3,065 

10, 714 

822 

950 

1,733 

9,007 

69,208 

22,501 

775 

10,610 

251 

1,000 

26,053 
18, 424 



Total . 



Nutrients a per person per day. 



93,944.6 
11,793.6 

2,628.2 

20,898.3 

1,043.3 

974.3 

2,222.7 

11,502.4 

6,241.1 

1,754.1 

117,944.2 

362.9 



164,297.5 

499.0 

2, 743. 4 

5, 412. 8 

88.9 

926.7 

1,647.9 

323.9 

919.4 

308.4 

4,632.2 
13,449.7 

1,704.6 
192.8 

1,486.0 

2,028.5 

1,229.7 
14,719.8 

4,046.6 
418.2 
408.2 

4,754.2 
171.5 

1,477.8 

398.3 

32.7 

4, 629. 4 

538.9 

60,640.9 

1,390.3 

4,859.9 
372.9 
430.9 
786.1 

4,085.6 
31,392.7 
10, 206. 5 

351.5 

4,812.7 

113.9 

453.6 

11,817.6 
8,357.1 



Kilograms. 
13, 809. 9 
1,533.2 

210.3 

2, 716. 8 
135.6 
133.5 
248.9 

1,506.8 

62.4 
454.3 

3, 892. 2 



18,729.9 

41.4 

458.1 

433.0 

7.6 

90.8 

192.8 

28.2 

59.8 



Kilograms. 
8, 924. 7 
2,830.5 

1,287.8 

5,558.9 
461.1 
119.8 
86.7 

1,069.7 

5,304.9 
591.1 

4, 717. 8 
362.9 



1, 643. 

3.0 

200.3 

16.2 

5.4 

84.3 

82.4 

27.9 

79.1 



Kilograms. 



111.2 



383.5 
34.9 
47.6 
42.6 
16.0 
206.1 
36.4 

7.5 

3.7 
57.1 

1.7 
20.7 

4.0 



60.2 

19.4 

1,091.5 

• 12.5 

43.7 

4.8 

7.3 

16.5 

28.6 

282.5 

91.9 

1.1 
77.0 

5.4 
8.2 



30.7 

2.9 

4.5 

6.1 

1.2 

29.4 

8.1 

2.1 

.4 

19.0 

.3 

4.4 

.4 



18.5 
1.1 

60.6 
1.4 
4.9 
1.5 
2.2 
2.4 
8.2 
125.6 

10.2 

1.1 

105.9 
1.1 



644, 84^. 9 



47,469.1 



11.5 



42.1 
5, 897. 2 



122,401.7 

394.2 

1,816.1 

4,276.1 

60.5 

677.4 

1,247.5 

241.3 



296. 
3,210.1 
12,777.2 

1,016.0 
127.0 
147.1 
140.0 

94.7 
706.5 
299.4 

19.7 

10.6 

366.1 

4.3 

131.5 

44.6 



500.0 

52.8 

8,914.2 

55.6 

291.6 
40.3 
16.4 
25.2 

183.9 
1,224.3 

581.8 

38.0 

3,181.2 

71.2 

282.1 



172, 613. 9 



351 



a These quantities would give a total of 2,398 calories per person per day. 



38 

In collecting such data no allowance could be made for amounts 
on hand at the beginning and end of the period covered by the 
figures, but it is believed that this does not introduce any great error, 
as the amounts were presumably not very different. 

The table from its very nature is not entirely accurate, for the 
reason that in making it up a number of assumptions were necessary. 
The assumptions were, however, made as carefully as possible, largely 
with the help of one of the institution officials, and it is believed that 
they are not very far from the truth. In the first place, it was not 
always possible to obtain the amounts of foods purchased for inmates 
distinct from that purchased for employees, and in such cases esti- 
mates had to be made, based on the proportion of the two classes to 
one another. Also there were certain articles of food purchased 
which were not supplied to the inmates as a whole, but only to a 
certain number of them. Such, for example, are eggs, which were 
served almost exclusively to sick or infirm patients. In the second 
place, more or less error was unquestionably introduced in estimating 
the weights of the various articles which were recorded in bulk. Par- 
ticularly is this true of the farm products, the data for which were 
taken from the report of the city board of charities for 1904. These 
products were given variously in bundles, bushels, heads, barrels, etc., 
the weights of which could not be accurately determined, since they 
may vary within considerable limits. However, it is not likely that 
the errors are important, since the farm products, which introduced 
the chief uncertainty, form only a minor part of the whole food 
supply for the entire year. 

The data in the table (p. 37) show the total amounts of nutrients 
in the food consumed by the inmates during one year to have been, 
respectively, 47,469.1 kilograms protein, 33,911.7 kilograms fat, and 
172,613.9 kilograms carbohydrates. By dividing these by 365, the 
number of days in a year, and the quotients thus obtained by 1,348, 
the average daily population of Bayview for the year ending Decem- 
ber 31, 1904, a the amounts supplied per person per day are found, 
namely, 96 grams protein, 69 grams fat, and 351 grams carbohydrates, 
with a total fuel value of 2,398 calories. 

As is discussed on page 36, the waste in this institution was very 
small, probably not greater, on the average, than 3 per cent of the 
food provided. Allowing for this proportion of waste, the amount 
actually eaten per person per day would be 93 grams protein, 67 
grams fat, and 340 grams carbohydrates. These amounts are con- 
siderably smaller than the per capita allowance at the Government 

a Since the table represents purchases of food from May, 1904, to May, 1905, 
this average does not represent precisely the same period. It is not believed, 
however, that the true figures would be enough different to change the results 
by more than one or two units either way. 



39 

Hospital for the Insane, but the studies are not directly 'comparable, 
for the reason that the latter includes a far greater proportion of 
employees with very much greater muscular activity, and also for 
the reason that at Bay view the ratio of hospital patients, other than 
insane, to the total number of inmates is greater. It is interest- 
ing to note that the figures in the table (p. 37) agree closely with 
the standard (100 grams protein and 2,950 calories of energy) pro- 
posed by Atwater 6 for insane hospitals as regards protein, and 
show a somewhat smaller amount of energy than he proposed. These 
points will be more fully discussed later (p. 40). 

COST OF THE FOOD. 

It is interesting to compare the cost of the food per person per 
day at Bayview with similar data regarding other institutions and 
families. As nearly as this factor can be calculated, it was 6.94 
cents per day. In nine public institutions studied by Mrs. Ellen H. 
Richards and Miss Sarah E. Wentworth c for the institution commis- 
sioner of Boston, the cost of food for inmates ranged from 5.29 to 
9.89 cents per person per day. In the institutions which may perhaps 
be most properly compared with Bayview, namely, the Long Island 
and the Charleston almshouses, it was 7.54 and 7.73 cents, respectively. 

In families where such data have been recorded in connection with 
the dietary investigations carried on under the auspices of this 
Office, the cost of food per person per day has shown considerable 
range, being very low in a number of cases and very high in others. 
In the case of families living in the thickly congested districts of 
New York, Chicago, and Philadelphia, many of them of the type or- 
dinarily receiving aid from charitable organizations, the cost of food 
has ranged from 9 cents to 42 cents per person per day. With fam- 
ilies living in rural regions, the cost has been 5 to 28 cents. With 
families of professional men and others in similar circumstances, a 
range of 22 to 40 cents per person per day has been noted. With 
college students and college clubs the range has been from 17 cents 
to 97 cents. Judged by these values, which, though not numerous 
enough for final deductions, may yet be fairly regarded as showing 
something of the actual cost of food, it will be seen that the diet at 
Bayview was very low in cost. 

° U. S. Dept. Agr., Office Expt. Stats. Bui. 150. 

6 Dietetics in Relation to Hospitals for the Insane. U. S. Dept. Agr., Office 
Expt. Stas. Rpt. 1904, p. 473. 

c Rpt. Inst. Comm. [Boston], 2 (1897), p. 206. 



40 

RESULTS OF DIETARY STUDIES AT BAYVIEW. 

The principal objects of the dietary studies in the old-age home, 
as previously stated, were to secure data regarding the amounts of 
nutrients and energy in the diet of the aged men and women, and 
to learn something of the adequacy and suitability of the dietary with 
a view to supplying information which would be of value in judging 
of the institution food situation as a whole, and for making changes 
in the dietaries, should this seem necessary and desirable, and also 
for the collection of data of use in general discussions of nutrition 
problems. 

It is difficult to compare the results of studies at these institutions 
with dietary standards, since the activity of the different individuals 
of any given group varied very greatly. If the commonly accepted 
American dietary standards are to be used, it is necessary to select a 
standard for each group which will, so far as possible, conform 
to the amount of muscular work performed by the average individual 
of the group studied, and in making such a selection it seems better 
to err on the side of too high values than too low, as every precau- 
tion should be taken in institution dietetics to avoid any tendency 
toward underfeeding. 

For the dietary study with regular patients and stable hands who 
had their meals in the men's dining room (study No. 682), the 
standard for a man performing light to moderate work, namely, 112 
grams protein and 3,050 calories of energy, seems best for purposes 
of comparison. This group undoubtedly included the most active 
of the men studied, yet it was evident that they did not perform 
an amount of work equivalent to the average day's labor in the fac- 
tory or on the farm. The diet corresponds with the standard selected 
very closely as regards energy and exceeds it as regards protein. 
While the amount of protein was not excessive when we consider that 
the time covered by the dietary study was short, and that, perhaps, the 
amount at other times would be somewhat less, there is no reason to 
suppose that these men could have required more protein than an 
average man outside the institution receives in his food. 

The ration allowance computed from the food purchased for a 
year, namely, 96 grams protein and 2,398 calories of energy, was 
probably amply sufficient when we recall that the proportion of inva- 
lids and hospital- ward patients was large, as was also the proportion 
of aged and infirm inmates. 

For the chronic and special diet patients included in dietary study 
No. 683, it seems hardly fair to use a standard for persons in health, 
since it is believed that the group did not represent the conditions 
which the standard is intended to cover. It seems certain that these 
men and women had all they could eat of the food provided, and 



41 

although they might have been tempted by a more varied diet to 
eat larger amounts, yet it does not seem at all probable that the 
energy supplied was insufficient for their needs, although it is some- 
what lower than the value, 2,700 calories, for a man of sedentary 
occupation. On the other hand, the protein requirement is in almost 
exact accord with the amount included in this standard. 

Dietary study No. 685, with men in the receiving ward, shows a food 
consumption of 111 grams of protein and 2,274 calories of energy. 
The subjects were not nearly as active as those of study No. 682, who 
obtained somewhat larger amounts of protein and energy, and it 
seems that their food requirements could not have been greater than 
those of " men with very little muscular exercise," namely, 90 grams 
of protein and 2,450 calories of energy, according to the commonly 
accepted American dietary standards. Judged by these values the 
dietary may be considered adequate as regards protein and energy. 
There were a number of young men in this group whose food con- 
sumption would naturally be greater than that of the old men in 
studies Nos. 682 and 683, and this probably accounts for the greater 
average amounts of food eaten. 

Dietary study No. 684, made with women inmates, shows that the 
amounts of protein and energy obtained were 85 grams and 1,924 
calories, respectively, per woman per day. Only half the women 
included in this group were classed as workers. Some of them were 
undoubtedly quite active, yet it seems fair to say that, considering 
the group as a whole, the degree of muscular activity was not great. 
The suggested dietary standards for women performing light to mod- 
erate muscular work call for 90 grams protein and 2,450 calories of 
energy, and the suggested standard for women having light exercise, 
80 grams protein and 2,250 calories. Perhaps the best values for 
comparison with the group studied would be an average of these two 
standards, namely, 85 grams of protein and 2,350 calories of energy 
per day. Compared with such values, the results obtained with the 
group of women studied show close agreement as regards protein, but 
a deficiency of about 400 calories as regards energy. The standard 
selected for the comparison refers to women in full bodily vigor, 
but many of those studied, as previously stated, were aged and infirm. 
When it is also remembered that the general health and appearance 
of the women of this group remained as good as usual, it does not 
seem probable that the diet supplied less nutritive material than was 
required. It would be a simple matter, however, to increase the 
energy value by adding some simple dishes to the menu, as stated 
above. 

One reason for believing that the women included in dietary study 
No. 684 received sufficient food for their needs is that the waste, 
though relatively small, was greater than was noted in the other 



42 

studies made at Bayview. It is a matter of general observation that 
where the food is of good quality little, if anything, will be wasted 
unless more is provided than is required. 

In general, it may be said that if the rations had not been sufficient 
for the inmates, losses in weight would have been very commonly 
noted and the physical condition of the inmates would not have been 
maintained. Many of the inmates were aged and infirm, and they 
naturally become more feeble with each year that passes ; but it was 
the opinion of the officers in charge of the institutions that, as a whole, 
the inmates maintained their physical condition and showed improve- 
ment rather than the reverse, which would indicate that the food 
supplied sufficient nutritive material for their body needs. Especial 
pains were taken to learn the opinions of the inmates regarding the 
sufficiency of the food supplied, and no one was found who expressed 
a belief that the dietaries were insufficient. The food was necessarily 
simple, and no great variety was possible at Bayview, and this lack 
of variety was frequently commented upon. A number of the in- 
mates expressed dissatisfaction with some particular dish, but such 
complaints were neither uniform nor general, so it seems perhaps 
fair to assume that the dietary was reasonably well relished. Taken 
all in all, the dietaries here considered can fairly be considered 
as adequate when judged by the condition of the subjects fed, by 
comparison with commonly accepted dietary standards, and by com- 
parison with the results obtained at other institutions and with the 
results of individual studies made with aged people. 

There is no reason to suppose that the amounts of nutrients and 
energ}^ furnished during the time these dietary studies were made 
differed very greatly from the amounts for other seasons, though it 
must be remembered that the studies were made in the late spring, a 
season which is perhaps least well calculated to give an especially 
favorable impression of the diet, since at this time of the year the 
vegetables stored for winter use are practically exhausted and the 
new crops have not matured. As fresh vegetables are high at this 
time of the year, they are, of course, hardly available, since the insti- 
tution funds warrant the purchase only of staple foods of reason- 
able price. For these reasons it seems possible that the studies 
reported represent the minimum rather than the average amounts and 
the more meager rather than the more generous menus. With the 
more varied diet made possible by a freer use of vegetables, it is very 
probable that larger amounts of suitable foods would have been eaten 
owing to better appetite. The amounts of food necessary to bring the 
dietaries up to the standards as regards energy are relatively small. 
For instance, had the subjects of dietary study No. 685 received an 
ounce more of bread per meal, the energy value of the ration would 
have been somewhat more than 2,450 calories per day. A pound of 



43 

ginger cake per person per week would have brought up the energy 
value of dietary No. 683 sufficiently to make it conform to the Voit 
standard. 

It is presumable that in the Bayview studies the aged persons ate 
less than the young and that dietary studies of individuals would have 
shown considerable variation from the average values for the group. 
If the group could -be subdivided on a basis of age, it seems very prob- 
able that the diet could be more carefully adjusted to the actual needs 
of individuals. Such a change would mean somewhat smaller amounts 
for the aged, with little muscular work, and for the younger persons 
amounts which would conform to the commonly accepted standards 
suggested for persons performing an equivalent amount of muscular 
work. If the groups could be so subdivided, special attention should 
be paid to providing soft foods and light and easily digested dishes 
for the aged. Changes like those suggested would necessarily mean 
that more time must be spent in the preparation of food and would 
very probably mean an increase in the cost of the diet. 

In discussing the Bayview almshouse dietaries it is interesting to 
note data regarding the Baltimore almshouse, reported some fifty 
years or more ago by J. S. Gould. a The data recorded include the 
bill of fare and in most cases the quantities served. The daily fare 
for nonworkers consisted of 8 ounces of bread with coffee for breakfast 
and a like amount of bread with tea for supper. On Mondays in 
winter dinner consisted of mush and molasses and in summer of rice 
and molasses. On Tuesdays and Thursdays 8 ounces of mutton made 
into soup and 4 ounces of bread made up the dinner and on Wednes- 
days and Saturdays 8 ounces of beef made into soup and 4 ounces of 
bread. The Friday dinner, like the Monday dinner, was mush or 
hominy and molasses. On Sunday 5 ounces of bacon or pork was 
provided and presumably 4 ounces of bread. Workers received in 
addition to the above 12 ounces of fresh meat or 9 ounces of bacon 
per day. In calculating the nutritive value of the soup it was as- 
sumed that a small quantity of potatoes or some similar material was 
used in its preparation, as is almost always the case, and it was neces- 
sary to make some assumptions regarding the amounts of mush and 
molasses eaten. Average values for the composition of the different 
foods were used in computing the nutritive value of the rations. As 
calculated, the dietary for nonworkers furnished 78 grams protein 
and 1,959 calories of energy and the diet for workers 85 grams of 
protein and 2,067 calories of energy per man per day, values smaller 
as regards both protein and energy than those in the average of the 
four studies made at Bayview. 

a A Report on Food and Diet Suited for Almshouses, Prisons, and Hospitals. 
New York, 1852, p. 79. 



u 

As may be seen from the figures in the table (p. S3), the different 
groups studied at Bayview received in their daily fare about the same 
quantities of protein and energy as the groups studied at the Xew 
York State hospitals for the insane, the Massachusetts almshouses, the 
Munich homes for the aged, and the Scotch poorhouses. where pauper 
lunatics are cared for. It will be seen that the Bayview dietaries 
contained somewhat more protein than the average of the dietaries 
regarded as deficient and somewhat less energy. Xo data were re- 
ported regarding the number of aged persons in the Scotch institu- 
tions, but it is perhaps fair to assume that no considerable number of 
them were aged and infirm persons, and the difference in the nutrients 
and energy value of the respective dietaries is perhaps explainable on 
this basis, as there is reason for believing that the Bayview dietary 
was as adequate as the dietaries considered adequate in the Scotch 
institutions. 

In order to compare the rations in these dietaries with the main- 
tenance rations suggested by Maurel it would be necessary to know 
the weights of the subjects. Unfortunately, it was not feasible to 
have the subjects weighed during any of the studies, but 25 average- 
sized inmates of each sex were weighed at Bayview a few months 
later and the average weight of the men was found to be 145 pounds 
kilograms) and of the women 118 pounds (54 kilograms . As- 
suming these figures to be applicable to the whole institution, the 
weights would indicate that the men averaged about 60 years of age 
and the women slightly more. Maurels maintenance ration for the 
men. then, would call for S2 grams of protein and 1 " lories 
energy, and the average Bayview ration supplied in excess of this 
grams of protein and 539 calories of energy, amounts amply sufficient 
for the slight external activity of the subjects. In the case of the 
women, the dietaries supplied IS grams of protein and 312 calories of 
energy more than Maurel's maintenance ration for a woman of 70 
years weighing 54 kilograms — probably ample protein and excessive 
energy for the slight external muscular work performed. 

In planning institution dietaries, whether for the aged, the middle- 
aged, or the young, humanity demands that some account be taken 
of the comfort as well as the bare nutritive requirements of the in- 
mates, especially when they have become wards of the public through 
no fault of their own. To what extent the dietitian is justified in 
going beyond the minimum ration which is consistent with safety, or 
beyond the minimum cost for the sake of variety, must depend upon 
the character of the institution and the funds at its disposal. There 
are. however, many methods by which variety can be increased with 
little or no increase in cost. 



45 

Dunlop, in a discussion of some of the essential points of a good 
institution dietary, states that it must contain a sufficient quantity of 
energy-yielding food and sufficient protein as compared with the 
commonly accepted dietary standards, and that it shall not contain an 
excess of carbohydrates or, in other words, fat and carbohydrates 
must be present in a reasonable ratio. The inmates must be classi- 
fied, both as to sex and the amount of work performed. The diet 
must be divided into meals of reasonable amount, must be of suffi- 
cient variety and pleasing, must contain a sufficient amount of condi- 
ments and a fair allowance of potatoes or other fresh vegetables. 

In dietary studies which were undertaken in Scotch prisons by 
him, 5 it was observed that the subjects lost weight and were discon- 
tented with a ration which supplied less energy than the usually 
accepted dietary standards called for, and that when this deficiency 
was made good by increasing the bread allowance somewhat, the com- 
plaints ceased and weight was maintained. In the Scotch institu- 
tions studied it seems probable that no large proportion of the 
inmates were aged and infirm, and this may account for the fact that 
they seemed to require somewhat larger amounts of energy for main- 
tenance than the groups studied in Baltimore. In planning institu- 
tion dietetics it is obvious that the aim should be to supply too much 
food rather than too little, as the inmates should not be generally 
undernourished. As previously noted (p. 21), bread was supplied 
at Bayview, so the inmates could have increased the energy value of 
their diet by eating more bread, if the appetites were not satisfied. 
If it seemed desirable to increase the energy somewhat by providing 
some food which would supplement the energy value of the diet in 
a more appetizing way than an increased consumption of bread, this 
could be readily done with little expense by adding gingerbread 
occasionally to the dinner or supper menu, or some other inexpensive 
dish, like macaroni cooked with cheese or tomatoes, or baked beans. 
These dishes, which commonly form a part of the diet in many public 
institutions, would also increase the proteid value of the dietary and 
would undoubtedly do much to relieve the monotony of the diet and 
add to its palatability. 

To secure the needed variety in institution dietetics Dunlop a states 
that changes in the dinner menus must be relied upon to a great ex- 
tent, and supper and breakfast almost always of necessity consist of 
bread and tea or coffee or some similar combination. To secure this 
variety in the dinners he suggests that no individual soup, broth 

a Report on dieting of pauper lunatics in asylums and lunatic wards of poor- 
houses in Scotland. Ann. Rpt. Gen. Bd. Comrs. Lunacy Scot., 43 (1902), Sup. 
6 Scot. Med. and Surg. Jour., 8 (1901), p. 405. 



46 

excepted, should be served oftener than twice a week; that the meat 
and the method of cooking it should be varied, boiled beef being 
served not oftener than three times weekly. Puddings, sweetened and 
flavored, should be supplied at times. The same menu should not 
be served oftener than twice a week, and the weekly routine should 
be periodically revised and made to include seasonable dishes. Ehu- 
barb, apples, etc., should be used when readily procurable. Such 
factors were considered in planning the Bay view rations, and in the 
other homes for the aged where studies were made it was possible to 
pay even more attention to such matters, as the resources were more 
abundant. 

When dietary conditions at Bay view were made a subject of special 
attention several years before the dietary studies reported in this 
bulletin were carried on (p. 18), a number of changes were intro- 
duced which added much to the comfort of the inmates, and which 
are of a sort which should always be possible when needed, as they 
do not involve increased expenditure. For instance, cereal breakfast 
foods were introduced as a breakfast dish in place of some of the 
bread previously issued, and were much appreciated by aged persons 
to whose needs soft foods are especially suited. Recognizing the fact 
that the flavor of browned meat is very appetizing to most palates, 
care was taken to provide at intervals meat thus cooked, instead of 
meat boiled in soup, which is such a universal dish in public institu- 
tions. Other similar changes were made in the menus which, though 
inexpensive and entailing little additional labor, added much to the 
palatability of the diet. 

DIETARY STUDIES IN HOMES FOR THE AGED AND ORPHAN 
ASYLUMS UNDER PRIVATE MANAGEMENT. 

The five studies in institutions in Baltimore reported in the follow- 
ing pages were conducted a year later than those at Bayview, and the 
data were collected by H. L. Knight of this Office. Three of the 
studies (Nos. 686 to 688) were made in homes for the aged under 
private management, one (No. 690) in an orphan asylum of the same 
character, and one (No. 689) in an orphan asylum supported largely 
by public funds. Each study lasted seven days. The general method 
followed was that sometimes known as " the family method," and de- 
scribed in detail in previous publications of this Office. Records were 
made of all the kinds and amounts of food on hand at the beginning 
of the study, of those brought into the institution throughout its 
course, and of those remaining at the end. The difference between the 
first two and the last amounts was assumed to represent the food pro- 
vided for the period under consideration. The refuse — that is, the 

a U. S. Dept. Agr., Farmers' Bui. 142 ; Office Expt. Stas. Bui. 150. 



47 

inedible material in some foods, such as bones, prune pits, eggshells, 
etc. — was, in most instances, separated and weighed, its amount being 
deducted from the weights of the foods as purchased to give the 
quantities of edible materials. In all such cases analyses of the edible 
portions of the foods are utilized in calculating the amount of nu- 
tritive material. In those instances in which determination of the 
amount of refuse was impracticable^ recourse was had to analyses of 
materials as purchased. The waste was in each case carefully 
weighed and a composite sample retained for analysis, except in study 
No. 689, where the entire amount was saved and analyzed. The 
nutrients in the waste were calculated and subtracted from those 
found for the total food provided, and the difference was taken as 
the total, amount eaten. The amount consumed per inmate per day 
was determined in the usual manner, by dividing the total food con- 
sumed by one-third of the aggregate number of meals served, due 
allowance being made for difference in sex, age, activity, etc., although 
in some instances the presence of groups of persons whose relative 
nutritive requirements were somewhat doubtful introduced compli- 
cations which will be explained in connection with the individual 
studies. 

Supplementary information as to the age, activity, body weight, 
etc., of the inmates was obtained whenever practicable. 

DIETARY STUDY NO. 686. 

The home for aged women in which this study was made is under 
the control of a board of management representing a Baltimore phil- 
anthropic association, which delegates the immediate charge to a 
house matron, assisted by a room matron and a nurse. The institu- 
tion is supported largely by private funds, but the State makes an 
annual appropriation of $3,000 for the joint use of this home and the 
affiliated home for aged men. Candidates for admission must be 
60 years of age or over, the preference being given to older women ; 
they must be of good character and without husband or children. An 
entrance fee is required varying from $200 to $300 according to the 
age of the applicant. For residents of other States than Maryland 
there is an additional charge of $500. At the time of the study there 
were 75 inmates, all that the home could accommodate. 

The building is a large three-storied brick structure erected about 
fifty years ago. It was in good condition but not modern. The 
kitchen, pantry, storerooms, and dining room were in the basement. 
At the time of the study a new range had just been installed in the 
kitchen, but there were few labor-saving devices, such as bread- 
mixing machines, bread slicers, etc. The dining room was large, 
well lighted, comfortably furnished, and well adapted to its purpose, 



48 

and was kept neat and clean. There were seven small tables seating 
from 6 to 12 persons each. 

Meals were served at 7 a. m., 1 p. m., and 6 p. m., from April 1 to 
October 1, and at 7.30 a. m., 1 p. m., and 5 p. m. the remainder of the 
year. All inmates physically able were required to be present punc- 
tually. The attendance at meals varied considerably, not only on 
account of inability to come to the dining room, but because the 
inmates were generally allowed to visit friends outside the institution. 

Those unable to come to the table were served in their rooms just 
before the regular meal hours. During the study about 20 women 
were thus served, though few of these were actually ill. The man- 
agement hoped soon to install a passenger elevator in the building; 
with such an arrangement many of the inmates who are too feeble to 
climb stairs could have come to the dining room regularly. Since 
the completion of the study an elevator has been provided. 

According to the rules of the home the " inmates are expected to 
make themselves useful in such ways as their services may be valu- 
able for the benefit of the home." A few took care of the corridors, 
pared potatoes, and occasionally washed dishes, but in most cases 
they showed little inclination to do more than care for their own 
rooms and mend and iron their clothes. 

The servants, 1 man and 7 or 8 women, were all negroes. The 
kitchen force consisted of a skillful and industrious cook and 3 
helpers, who washed dishes, waited on table, etc. At the time of the 
study the house matron had but recently been appointed. 

PURVEYING OF FOOD. 

As there were no cold-storage facilities little attempt was made to 
buy in large quantities. The matron bought the meats and vegetables 
each day from the neighboring markets. Groceries were purchased 
twice a week, butter and eggs weekly. Potatoes were obtained by the 
bushel, flour and sugar by the barrel, and coffee and tea in 25-pound 
bags. It was a point of pride with the matron that the food pur- 
chased was invariably of good quality. Friends of the institution 
frequently sent donations of canned goods, fancy cookies, fruit, vege- 
tables, and occasionally turkey or other such delicacy, and ice cream. 
These donations arrived somewhat irregularly ; nevertheless it seemed 
to be the policy of the institution to depend upon them in considerable 
measure for the luxuries and variety of the table. In the opinion of 
the matron less than usual was sent in during the week of the study. 
The inmates were strictly forbidden to buy or solicit food from out- 
side, as it was thought this might give the institution an undesirable 
reputation, but nevertheless some was undoubtedly smuggled in. The 
visitors who were allowed on Thursday and Friday afternoons also 
brought delicacies to their friends among the inmates. It was, of 



49 

course, impossible to determine how much was obtained in these two 
ways. One attendant thought it was as much as 10 per cent of the 
food eaten, but this estimate is probably too large. A good share of 
the inmates had no money, and careful observation indicated that 
while a few individuals received a not inconsiderable portion of their 
food in this way the average amount was not large. Moreover, the 
food thus obtained was mostly fruit, the nutritive value of which 
would be even less significant than the quantity. It seems safe to 
assume, therefore, that no great error is introduced into the results of 
this study by such unrecorded materials. 

KINDS OF DIET. 

The sick were given special diets when necessary, but at the time 
of the study there was little actual illness, and the meals served in 
the inmates' rooms differed from those in the dining room princi- 
pally by the addition of jelly. Eggs, either raw or boiled, were fur- 
nished to any inmate who desired them in the place of meat at 
breakfast or dinner. Tea was served at each meal, and an alternative 
of coffee was offered at breakfast and supper. 

The matrons and attendants ate in the dining room immediately 
after the inmates had finished. Their diet was the same as that of 
the inmates, except that they occasionally bought for themselves small 
amounts of fruit, vegetables, etc., for the sake of variety. These were^ 
not included among the foods measured, because they were believed 
to be in excess of the regular diet ; that is, the matron and attendants 
ate the regular diet plus these supplemental foods, and to disre- 
gard them seemed to give a more accurate average for the institution. 

No special diet was provided for the servants, who were expected 
to make their meals of what was left after the others had been served. 
They complained that this was frequently insufficient, and it is unde- 
niable that the supply of one or more articles was sometimes ex- 
hausted in the dining room. There was always, however, an unlim- 
ited supply of bread. 

METHOD OF SERVING. 

Most foods were placed on the tables in large dishes and the in- 
mates allowed to help themselves. Bread was provided ad libitum 
at all meals, as were milk and sugar for the tea and coffee. Butter, 
oatmeal, some vegetables, and fruit were served in individual por- 
tions. A second helping was allowed when practicable, but was sel- 
dom called for. 

UTILIZATION OF REMNANTS. 

Since the food returned from the tables was largely consumed by 
the servants, but little had to be utilized in other ways. Any butter 
16553— Bull. 223—10 4 



50 

remaining on the butter plates was collected after the meal by the 
matron and used in cooking. The sliced bread, of which considerable 
quantities were returned from the table, was allowed to accumulate 
until there was enough to serve either fried as " French toast " or 
toasted. Twice during the study bread which had become very dry 
was thrown away by the servants, but this was contrary to the ma- 
tron's orders. 



Unfortunately it was impracticable to get definite information on 
these points during the study. Ten months later the secretary of the 
home reported that the minimum age of inmates was 65, the maxi- 
mum 90, and the average 76 years, and these statistics had probably 
not been materially altered by deaths or new admissions since the 
study was made. The high minimum age is significant. While 
women may be admitted at 60, the number of applicants is so great 
that they are rarely taken at ages under 65. 

There was no opportunity to weigh the inmates during the study, 
and the only way of obtaining an idea of their weight was to estimate 
it by carefully noting the size of the women as they passed into the 
dining room. This was done on two successive days, and as the in- 
mates entered in different orders on the two days and the two esti- 
mates were very similar, it is thought worth while to note the esti- 
mated average, namely, 131 pounds. To estimate their height a mark 
was made 5 feet from the ground on the post of the doorway through 
which the inmates entered, and the height of each woman was esti- 
mated as she passed through. The figures obtained in this way aver- 
aged 5 feet 1 inch. Of course both these measurements are too crude 
to have any but a most general significance. 

The character of the meals served during the study is indicated by 
the following sample menu : 

Menu foe Saturday, May 12, 1906. 

Breakfast: Pork sausage, fried; rolled oats, tea, coffee, butter, bread, milk, 
sugar. 

Dinner : Potatoes, boiled or baked ; spinach, beefsteak, bread, butter, sugar, 
milk, tea. 

Supper : Gingerbread, white bread, tea or coffee, milk, butter, sugar. 

ATTENDANCE. 

One day was spent in preliminary observations at the home; the 
study proper began with dinner on May 11, 1906, and was continued 
for a full week of 21 meals. During that time 967 meals were served 
to inmates at the main table, 414 to inmates in their rooms, 52 to at- 
tendants, 143 to female servants, 17 to male servants, and 2 to the 
observer, making a total of 1,595, or the equivalent of one person for 



51 

532 days. While the attendants and servants undoubtedly ate more 
than the inmates, the difference is not believed to be sufficiently large 
to introduce a significant error if ignored in the calculation of the re- 
sults of the study, and so no attempt has been made to include such a 
correction in calculating the results. 

A word of explanation should perhaps be given concerning the 
material designated " Food unused at end of study " in the table fol- 
lowing. This represents either foods which had been returned from 
the dining room and would be utilized at later meals, or, as in 
the case of tallow, parts of the raw materials set aside during their 
preparation. Since it forms part of the food measured, its nutrients 
must, of course, be subtracted from those of the total food in order to 
determine the amounts actually consumed, but it is in no wise to be 
considered as waste. 

Weight of total food, and protein and fuel value of food per woman per day, 

dietary study No. 686. 



Kinds and amounts of food materials. 



Amounts per 
woman per day. 



Protein. 



Fuel 
value. 



ANIMAL FOOD. 

Beef: Ribs, 23.88 pounds (2); round, 35.19 pounds (4); shoulder and clod, 9.31 pounds 

(6): steak, Hamburg, 12.44 pounds (11); dried, salted, and smoked, 7 pounds (13).. 

Lamb: Leg, 21.31 pounds (15) 

Pork: Fresh chuck, ribs, and shoulder, 22.44 pounds (19); ham, fresh, 21.50 pounds 

(20); shoulder, smoked, 41.44 pounds (26) 

Sausage: Pork, 13.06 pounds (34) 

Fish: Weakfish, 24.38 pounds (36); cod, salt, 6.56 pounds (38); herring, salted and 

smoked, 36.25 pounds (39) 

Eggs: 25.50 pounds (41) 

Dairy products: Butter, 18.44 pounds (42); cheese, full cream, 3.31 pounds (43); 

milk, 430 pounds (44) 

Lard: 17.38 pounds (47) 



Grams. 
15.7 
3.5 

11.1 

1.4 

16.2 
2.6 

13.0 



Total animal food . 



VEGETABLE FOOD. 

Cereals: Corn meal, granular, 13.31 pounds (50); oats, rolled, 25.44 pounds (53); rice, 
4.19 pounds (55); wheat flour, 253.19 pounds (59); macaroni, 5.Q6 pounds (63) 

Sugars, etc.: Molasses, 9.75 pounds (77); sugar, granulated, 93.19 pounds (79) 

Vegetables: Greens, dandelion, 14.44 pounds (91); lettuce, 8.25 pounds (94); onions, 
2 pounds (95); potatoes, 216.13 pounds (100); rhubarb, 13.88 pounds (102); spinach, 
19.13 pounds (105); tomatoes, canned, 15.13 pounds (111) 

Fruits: Lemons, 0.50 pound (117); peaches, dried, 6 pounds (121); raisins, seeded, 
2 pounds (125); plums, preserved, 9.19 pounds (129); jelly, plum, 0.75 pound (132). 

Total vegetable food 

Total food 



FOOD TJNCONSUMED. 



Unused at end of study: Beef, roast, cooked 2 pounds (9); ham, smoked, fried, 0.94 
pound (25); herring, fried, 1.06 pounds (40); tallow, 1.75 pounds (4.8); oats, 
rolled, cooked, 2 pounds (54); bread, wheat, 24.88 pounds (66); peaches, stewed, 
0.75 pound (122) 

Waste: 200.25 pounds (139) 



Total food unconsumed . 
Total food consumed. . . 



63. 5 



4.3 
.3 



97.2 



2.9 
9.0 



11.9 



85.3 



Calories. 
177 
42 

321 

52 

116 
30 

163 
138 



1,039 



939 
349 



146 
41 



1,475 



83 
225 



2,206 



52 

WASTE. 

The waste from each meal was weighed, run through a meat chop- 
per, and thoroughly mixed; a 10 per cent sample was then removed 
for analysis, a few drops of a 40 per cent solution of formaldehyde 
being added to prevent decomposition. In this study kitchen and table 
waste were measured and analyzed together, amounting in all to 200 
pounds 4 ounces, and containing about 10 per cent of the protein and 
energy of the food. While this is not a large proportion as compared 
with that found in many public institutions, it is somewhat higher 
than that in the other studies of this series. At least a partial ex- 
planation lies in the fact that so many meals were served to the in- 
mates in their rooms. Since there was no chance for a second helping 
in these cases, it was necessary to send up generous portions, consider- 
able quantities of which were returned uneaten, and for sanitary 
reasons thrown away. In order to determine how great was this loss, 
the waste returned from the private rooms was kept separate from 
that from the kitchen and dining room. It was found that the total 
waste from the kitchen and dining room was but 96 pounds 3 ounces, 
a little less than one-half the total. On the other hand, that from the 
separate meals, which served less than one-third of the total popula- 
tion, was 104 pounds 1 ounce, of which 22 pounds 5 ounces was bread, 
28 pounds 12 ounces solid food other than bread, and 53 pounds liquid 
waste, chiefly tea and coffee, to which milk and sugar had been added. 
The wasted bread alone contained 932 grams protein and 27,814 
calories of available energy, or about 20 per cent of the nutrients of 
the total waste. As long as the present practice of serving so many 
meals in rooms was continued, this source of waste seemed likely to 
remain, for it would have been a difficult matter to decrease the size 
of the portions served without giving offense. Now that the desired 
passenger elevator has been installed, this loss should be considerably 
diminished. At the time of the study, meals were sent up to about 
20 inmates, of whom all but 5 or 6 could have come to the dining 
room in an elevator, and not only the labor of serving them in their 
rooms but also considerable food could thus have been saved. 

ADEQUACY OF THE DIET. 

An earnest attempt was made to get the frank opinion of the. in- 
mates regarding the diet at the home, and no complaints were made 
as to the quantity of food. The desire to obtain special food from 
outside might seem an indication of insufficient rations, but the true 
reason probably lay rather in the wish to secure variety and luxuries, 
which the institution could not be expected to furnish. Careful ob- 
servation of the inmates gave no reason to suppose that they were not 
abundantly supplied with the necessary food. 



53 

As regards the amounts of protein and energy actually eaten, the 
table (p. 51) shows them to be 85 grams of protein and 2,206 calories 
of energy per woman per day. These figures are almost identical with 
the proposed standard — 85 grams protein and 2,200 calories energy. 
Such a very close agreement, of course, has no special significance, but 
since there is no reason to suppose that the diet in this study was not 
well adapted to the needs of its subjects, it may be considered a cor- 
roboration of the standard. 

COST AND SELECTION OF FOOD. 

According to the report of the home for 1906 the expenditure for 
provisions during that year was as follows: Meats, $1,630.74; poultry 
and fish, $342.76; milk, butter, eggs, and ice, $1,466.54; groceries, 
$1,115.63; vegetables, $533.48; making a total of $5,089.15. Judging 
by the cost of the ice used in the men's home, it may fairly be 
assumed that $100 was spent for this item in the women's home ; sub- 
tracting this from the total sum, we find the amount expended for 
food alone to be $4,989.15. With an average population of 76 this is 
equivalent to $1.26 per inmate per week, or 18 cents per day. 

While this amount is larger than that found in the German Aged 
Peoples' Home (see p. 59), it can not be considered excessive for the 
quality of the food provided. A diet supplying equal amounts of 
nutrients at less cost could easily be selected, but it is very doubtful 
whether such a change would prove either acceptable or wise. The 
situation in this home is not that in a free public institution. The in- 
mates in general have come from comfortable homes and have paid 
a considerable sum on admission; they would be justified therefore in 
demanding a certain amount of the more expensive foods which give 
variety in the diet. While it was the policy of the institution to pay 
considerable attention to economy, an effort was also made to provide 
foods of the same general character as those to which the inmates had 
been accustomed before their admission. For example, it was a pe- 
culiar feature of the diet that very few of the cheaper cuts of meat, 
particularly those suited for soup making, were used; the matron 
feared that the introduction of such materials would arouse dissatis- 
faction, as savoring somewhat of the practice in the institutions for 
the poor. Whether or not this prejudice could be overcome is an 
open question. Such meats are very palatable when used as well- 
seasoned stews, as beef a la mode, and in similar ways, and of course 
often appear on the table of families in comfortable circumstances. 
It would seem to an outsider that money might occasionally have 
been saved in this way and expended, say, for desserts, of which none 
were regularly provided. Similarly, the use of tub butter in the place 
of pound prints for table use, and the substitution of something 
cheaper for cooking, would have made a considerable saving without 



54 

rendering the food less attractive. Another minor point is also sug- 
gested by a study of menus. Eolled oats were served every morning 
as breakfast cereal, and there was some complaint of monotony. 
While the oats are probably as cheap as any cereal, the occasional 
substitution of a similar wheat or corn preparation, or even of a ready - 
to-eat cereal, would have obviated this criticism without adding more 
than a few cents to the cost of the meal. An unsuspected source of 
loss was brought to light by the study ; previously, the weight of goods 
purchased had not been checked on their arrival at the home, and 
when they were weighed by the observer it was found that some of 
the dealers were sending short measure ; the matron at once procured 
a pair of spring balances and stopped this practice. 

It should be remembered that many items of the diet came as gifts 
from friends of the institution and are not included in the expendi- 
tures. As they include practically all the more expensive materials, 
their money value must have amounted to a considerable sum during 
the year, a fact which should be borne in mind in comparing the cost 
in this and other studies. From the point of view of the dietitian it 
would probably have been more convenient to receive the money 
equivalent of such gifts and expend it for similar luxuries at discre- 
tion rather than to depend on the irregular donations in kind for 
this part of the diet. It may well be, however, that the more direct 
personal interest which such donations foster between an institution 
and its friends more than compensates for the inconvenience. As 
was previously stated, the matron thought that these gifts were less 
numerous than usual during the week of the study. 

Other conditions may also cause slight variations in the character 
of the diet from week to week, but it is believed that if due allow- 
ance be made for the season of the year, the results of this study are 
fairly typical of the usual diet. All things considered, they indicate 
that the institution was getting a fair return for its expenditures for 
food. 

DIETARY STUDY NO. 687. 

The home for aged men in which this study was made is under 
the same management as the home for aged women (see study No. 
686), and the regulations under which its inmates are received and 
governed are practically the same as in that institution. At the 
time the study was made it was in charge of a man and his wife 
who had served as superintendent and matron for seventeen years. 
They were aided by an assistant matron and 6 negro servants, 2 men 
and 4 women. The building, which adjoins the home for aged 
women, resembles it in general appearance and arrangement, though 
it was erected ten years later, and is smaller, accommodating only 50 
inmates. The kitchen, storerooms, and dining room are in the base- 



55 

ment. The kitchen and storerooms are small, and contained few 
labor-saving devices beyond a bread mixer. As in the women's home, 
a dumb-waiter connects with the upper stories. In the dining room 
was one long table, at which the inmates were served. The men 
left the table as quickly as they pleased, often remaining no longer 
than ten minutes and seldom more than fifteen. The superintendent 
and matrons had a small private dining room, in which they ate just 
after the inmates had finished. The servants ate in the kitchen, 
their food consisting largely of what was left from serving the main 
table. 

At the time of the study there were 41 inmates, 3 of whom were 
aged women, who were temporarily accommodated here because of 
insufficient room in the women's home. Their meals were served in 
their rooms, as were those of 8 men too infirm to go to the dining 
room. 

As in the women's home, the inmates showed little inclination to 
do any work beyond taking care of their rooms, though 2 of the men 
regularly wiped the dishes. The bodily activity of the men Avas 
probably a trifle greater than that of the women in the previous 
study. Ten months after the study the minimum age in the home 
was reported as 60, the maximum 89, and the average 75, and there 
is no reason to suppose that the figures had changed much in the 
interim. 

PURVEYING OF FOOD. 

The marketing was done daily by the superintendent, who showed 
good judgment in following the market and taking advantage of 
any favorable prices. The food purchased was invariably of good 
quality. Although the men's home depended largely upon donations 
for its delicacies, these seemed less frequent than in the women's 
home. Much less food was brought in by the inmates than in study 
No. 686. 

KINDS OF DIET. 

Whenever it was needed, a special diet was served to the sick, in 
which eggs, jellies, etc., were freely used. The attendants varied 
the regular diet by small amounts of fruit, etc., but not to any 
great extent. Such articles .and the " extras " served to the sick are 
not listed in the menu, but are included and specially marked in 
the table on page 57 ; as they were eaten mainly in small proportions 
in excess of the regular diet, they were not considered in estimating 
the amounts of nutrients consumed per man per day. 

METHOD OF SERVING. 

The food was prepared mainly by the matron and her assistant, 
and was well cooked and neatly served. Most of the articles were 



56 

placed on the table in large dishes, from which the inmates helped 
themselves. Bread was supplied ad libitum, and a second helping 
of most other things allowed. The men were expected to eat every- 
thing on their plates, and usually did so. Butter was served in indi- 
vidual portions at breakfast and supper, but not at all at dinner. 
Milk and sugar were added to the tea and coffee and the cereals 
before serving. Milk was considered too expensive ever to be used 
as a beverage. 

UTILIZATION OF KEVEXAXTS. 

As in the previous study, most of the food returned from the serv- 
ing dishes on the tables was consumed by the servants. The butter 
remaining on the plates after all had finished was used to spread on 
the bread for the infirm and blind, a practice which seems unneces- 
sarily economical. 

The kind of meals served during the study is indicated by the 
following sample menu, which has been selected as a fair average : 

Mexv for May 19. 1906. 

Breakfast: Irish stew (beef and potatoes), rolls, bread, butter, tea or coffee 
with milk and sugar. 

Dinner : Roast inutton. boiled rice, lettuce salad, strawberries, sugar, bread, 
tea or coffee with milk aud sugar. 

Supper : Chipped beef with milk gravy, bread, butter, tea or coffee with milk 
and sugar, currant jelly. 

ATTEX'DAX'CE. 

After a day of preliminary observation the study began with sup- 
per on May IS, and was continued through 21 meals. During this 
period a total of 1.000 meals was served. 821 to men and 179 to women. 
The women in the home were of two classes, 5 attendants and 
servants and 3 elderly women who were awaiting transference to 
the women's home. While as a rule in such studies the food consump- 
tion of women is assumed to be 0.S of that of men. this factor was not 
used. As regards the female attendants and servants, their bodily 
activity was so much greater than that of the inmates of either 
sex that if anything they ate more, rather than less, than the men. 
As regards the women inmates, their number was so small that no 
large error could be introduced in assuming that their food consump- 
tion differed very little from that of the elderly men. It therefore 
seemed most feasible to treat the population as homogeneous and to 
calculate the results on this basis, but to take the differences into ac- 
count in interpreting them. Accordingly the figures per person 
per day in the following table were obtained by dividing the total 
amounts of protein and energy by 333. one-third of the total number 
of meals served. 



57 

Weight of total food, and protein and fuel value of food per man per day, 

dietary study No. 687. 



Kinds and amounts of food materials. 



ANIMAL FOOD. 

Beef: Chuck, including shoulder, 16.31 pounds (1); ribs, 10.81 pounds (2); round, 
22.06 pounds (3); steak, Hamburg, 9 pounds (11); liver, 7.63 pounds (7); boiled, 
9.44 pounds (8); dried, salted, and smoked, 6.69 pounds (13) 

Mutton: Leg, 33.69 pounds (17); shoulder, 3 pounds (18) 

Pork: Chuck, ribs, and shoulder, 18.5 pounds (19); ham, smoked and boiled, 15.44 
pounds (24); backs, dry-salted, 16.44 pounds (27) 

Sausage: Bologna, 5.69 pounds (30) 

Fish: Cod, salt, 12.13 pounds (37) 

Eggs, 37.56 pounds (41) 

Dairy products: Butter, 21.44 pounds (42); milk, 142.38 pounds (44) 

Gelatin, 0.38 pound (45) 

Lard, 7.06 pounds (47) 



Total animal food. 



VEGETABLE FOOD. 

Cereals: Cornmeal, granular, 6.56 pounds (50); hominy, 3.56* pounds (51); oats, rolled, 
boiled, 2.13 pounds (54); rice, 4.81 pounds (55); rice, boiled, 1.13 pounds (56); wheat 
flour, 94.5 pounds (60); wheat breakfast food, rolled, steam-cooked, 4.81 pounds 
(62); bread, wheat, 30.25 pounds (66); rolls, 7.38 pounds (58); crackers, soda, 0.69 
pound (70); pudding, bread, 2.13 pounds (75) 

Sugars, etc.: Molasses, 5.25 pounds (77); sugar, granulated, 57.06 pounds (79); sirup, 
2.75 pounds (77) : 

Vegetables: Asparagus/* 1.19 pounds (81); cabbage, 26 pounds (83); lettuce, 4.88 
pounds (94): onions, 11.75 pounds (95); potatoes, as purchased, 142 pounds (100); 
potatoes, edible portion, 7.88 pounds (99); rhubarb, 1.94 pounds (102); rhubarb, 
stewed,^ 3.5 pounds (103); spinach, 7 pounds (105); peas, canned, 13 pounds (110); 
tomatoes, canned, 15.81 pounds (111) 

Fruits: Bananas, 20.81 pounds (115); lemons, 1.5 pounds (117); oranges, 3.81 pounds a 
(118); strawberries, 14.94 pounds (120); peaches, dried, 5.88 pounds (121); prunes, 
7.5 pounds (123); jelly, currant, 11.63 pounds (130); lemon, 0.94 pound (131) 



Total vegetable food. 
Total food 



FOOD UNCONSUMED. 

Unused at end of study: Beef and mutton, stewed, 7.13 pounds (138); pork, ribs, 

cooked, 1.94 pounds (22); fat, 7.19 pounds (46); pie, rhubarb, 1.06 pounds (74) 

Waste, 114.38 pounds (140) 



Total food unconsumed. 
Total food consumed 



Amounts per man 
per day. 



Protein. 



Grams. 

23.9 

9.0 

10.3 
1.5 
4.2 
6.1 
6.7 
.5 



62.2 



22.1 
.3 



1.1 

29.3 



1.4 
7.3 



8.7 



Fuel 
value. 



Calories. 
272 
120 

311 
19 
15 
72 

371 
2 



1,271 



717 
350 



185 
120 



1,372 



2,643 



110 
194 



304 



2,339 



a Served only with special sick diet. 
WASTE. 



As is shown in the above table, the total waste during this study 
amounted to 114 pounds 6 ounces, or 8 per cent of the protein and 7 
per cent of the energy of the food supplied. This amount is not 
large, as compared with that in many other institutions, and is smaller 
than that in the previous study. This difference is mainly due to 
the fact that the matron showed remarkably good judgment and 
tact in the size of portions sent to the rooms, and in this way cut down 
the amount of food returned uneaten. The waste in this study prob- 
ably could not have been decreased appreciably, unless possibly in one 
or two minor ways. A considerable part of the food discarded con- 



58 

sisted of meat, which had evidently proved difficult for the elderly 
men to masticate ; if such cuts could have been served in some softer 
form, such as stews or soups, of which the inmates seemed fond, some 
waste perhaps could have been prevented. As in many institutions, 
milk and sugar were added to the tea and coffee before serving-. 
Whether or not this practice is of real economy is an open question 
which has been discussed in connection with other studies (see p. 20). 
In the present case it seemed to the observer that the amount of waste 
was increased rather than diminished thereby. 

ADEQUACY OF THE DIET. 

The amounts of nutrients and energy furnished per man per day 
in this study were found to be 82.8 grams of protein and 2,339 calories 
of energy. This amount of protein is two or three grams lower than 
the standard or the amount found per woman per day in the former 
study. This difference becomes slightly greater when it is recalled 
that in all probability the servants and attendants ate more than was 
credited to them in the calculations, so that the amount actually 
consumed by inmates was, if anything, lower than that given. The 
energy supplied is about 140 calories more than the standard. There 
was little complaint of any kind among the men regarding the 
character of the food and none whatever regarding the quantity. 
The natural conclusion therefore is that the standard of 85 grams of 
protein is abundantly high for men in the decline of life ; as for the 
energy, all that can be safely said is that these men appeared con- 
tented and well nourished on an amount slightly higher than the 
standard. 

COST AND SELECTION OF FOOD. 

The amounts expended for food during the year are given in the 
report for 1906 as follows: Meats, $1,380.53; milk, butter, and eggs, 
$742.59 ; poultry, fish, and vegetables, $766.78 ; groceries, $797.25 ; mis- 
cellaneous marketing, $383.63 ; giving a total of $4,070.78. Assuming 
an average population of 48, the cost per man per week would be 
$1.63, or 23 cents per man per day. This amount is the largest found 
in any of the present studies, and is almost a third again as high as 
that found in the women's home. The reason for this is by no means 
apparent. The number of inmates was smaller, but the purchases 
were more frequently made in bulk, and apparently with better judg- 
ment and to better advantage than in the women's home. There may 
have been fewer donations, necessitating the purchases of more ex- 
pensive materials, but the list of gifts as published in the annual 
report hardly sustains this explanation. On the other hand, butter 
was used only twice a day in this study, and the food consumption is 
lower, at least as regards the more expensive protein. The reason is 



59 

probably to be found, if at all, in the larger proportion of nutrients 
supplied by meats ; in the first study these represent about 33 per cent 
of the protein and 24 per cent of the energy, while in the second they 
furnish 49 per cent of the protein and 27 per cent of the energy. Con- 
sidering that some of the inmates were frequently unable to eat por- 
tions of the meat as served and expressed a preference for soups and 
stews, it would seem easy and desirable to reduce this item, substitut- 
ing less expensive cuts for the roasts and steaks, or else using more 
milk and cheese and cereals. In this connection another minor sugges- 
tion may be made, namely, that a more frequent use of oatmeal at 
breakfast would be both acceptable and economical. In spite of these 
criticisms the fact remains that the diet here studied was well planned, 
well served, and gave decided satisfaction. An especially agreeable 
feature was the tact with which the matron succeeded in catering to 
the individual tastes of the inmates without disturbing the routine of 
the service or causing ill feeling; this personal consideration was 
manifested in other ways as well, and undoubtedly did much to pro- 
duce the contentment noticeable among the inmates. As in the 
women's home, the conditions of entrance justified the use of a certain 
amount of luxuries in the diet, and its cost should not be judged by 
the same standards as that in charitable or penal institutions. 

DIETARY STUDY NO. 688. 

This study was carried on at the German Aged People's Home, in 
the western part of Baltimore. Although there are no restrictions as 
to nationality, the home is managed entirely by Germans and the 
inmates are almost all German. The State grants an annual appro- 
priation of $1,500, and there are many annual subscriptions from 
German- American citizens. An admission fee of $200 is charged, 
and a considerable part of the annual income is also furnished by 
the inmates. Both men and women are received. The minimum 
age for admission is 60 years, but the applications are so numerous 
that few persons under 65 are admitted. The average number of 
inmates in 1906 was from 60 to TO; at the time of the study there 
were 27 men and 38 women. 

The home occupies a large, commodious three-story brick building 
erected in 1885. It is pleasantly situated on a rise of ground, and has 
about half an acre of land in its rear, devoted to lawns, gardens, and 
a hen yard. A flock of about 30 hens is kept, being cared for by one 
of the inmates and fed in part on table waste. 

The kitchen, storerooms, and pantry are in the basement, and 
except for the pantry, which is small and dark, they are large and 
well furnished. The equipment included a new range and a bread 
cutter, but few other modern labor-saving devices. A dumb-waiter 
runs from the kitchen to the dining room on the floor above. The 



60 

latter contains two long tables, one for the men and one for the 
women, and in all their appointments, like everything else at the 
home, are kept scrupulously clean and neat. 

The matron, her assistant, and the five servants, all German, have 
their meals in a small dining room in the basement, usually before 
serving the others. Their diet was exactly the same as that given 
the inmates in the dining room. 

Inmates too infirm to come to the main table were served in their 
rooms. A special sick diet was provided when necessary. During 
the study there was little real sickness. 

Since the close of the study a passenger elevator, screens, a gas 
range, electric lights and fans, and a steam laundry have been pro- 
vided. Additional improvements are contemplated. 

PURCHASE OF FOOD. 

The buying was done by the matron, who visited the markets almost 
daily. She showed good business ability, insisted on good quality, 
and took great pains to choose wholesome and economical food. A 
pair of scales was used to check purchases. Little or no food was 
donated to the home, gifts being made in money instead, a practice 
probably more satisfactory to the purveyor, as already pointed out. 

AGE AND WEIGHT OF INMATES. 

According to the report of the home for 1906, the average age of 
the 65 inmates then in the home was 78 years. An opportunity was 
given to weigh the inmates in the dining room at the close of one 
meal. The average weight of 18 men was 141J pounds; of 29 women, 
134 pounds ; or an average weight of about 137 pounds for both sexes. 
Of course the more infirm were not weighed, but their weights would 
probably not have noticeably changed the average. 

The character of the weekly menu is indicated by the menu for one 
day, which follows. 

Menu for June 5, 1906. 

Breakfast: Smoked sausage, bread, butter, coffee with sugar and milk. 
Dinner: Barley soup, lamb boiled, string beans, canned tomatoes stewed (left 
over from day before), potatoes, coffee with milk and sugar, bread. 
Supper : Bread, butter, tea with milk and sugar. 

ATTENDANCE. 

Owing to the necessity of finishing the study before the approach- 
ing fiftieth anniversary celebration of the home, the usual day of 
preliminary observation was dispensed with. The study began with 
dinner on June 2 and continued through 21 meals. During this time 
556 meals were served to men and 911 to women. Of the latter, how- 



61 

ever, 111 were served to female servants and the matron. As the 
activity of these women was much greater than that of the male 
inmates, it seems more reasonable to assume that the greater activity 
compensated for the difference in sex. The remaining 800 meals to 
female inmates were as usual assumed to be equivalent to 0.8 of that 
number for men. The total number of meals as served to male in- 
mates would therefore be 556+111+ (800X0.8=640) =1,307. This 
is equivalent of 1 man for 436 days. The protein and fuel value 
per man per day are given in the following table : 

Weight of total food and protein and fuel value of food per man per day, dietary 

study No. 688. 



Kinds and amounts of food materials. 



Amounts per man 
per day. 



Protein. 



Fuel 
value. 



ANIMAL FOOD. 



Beef: Shoulder and clod, 68.94 pounds (C) 

Veal: Leg, 29.75 pounds (14) 

Lamb: Leg, 18.88 pounds (15) ,. 

Pork: Ham, smoked, 36.25 pounds (23); salt, lean ends, 0.88 pound (29) 

Sausage: Frankfort, 14.38 pounds (31); pork, 18.44 pounds (32) 

Fish: Cod, 28.06 pounds (35) 

Eggs, 9.13 pounds (41) 

Dairy products: Butter, 38.69 pounds (42); milk, 224.13 pounds (44) 

Lard, 6.69 pounds (47) 



Total animal food . 



VEGETABLE FOOD. 

Cereals: Barley, pearled, 1.31 pounds (49); corn meal, granular, 2.69 pounds (50); 
oats, rolled, 6.63 pounds (53); rice, 6.69 pounds (55); rye flour, 1.63 pounds (58); 
wheat flour, 129 pounds (60); farina, 1.06 pounds (61); bread, rye, 24.81 pounds 
(65); macaroni, 5.06 pounds (63); cake, 49.13 pounds (71) 

Sugars, starches, etc.: Molasses, 0.63 pound (77); starch, corn, 0.31 pound (76); sugar, 
granulated, 50.94 pounds (79); sugar, powdered, 6.38 pounds (80) 

Vegetables: Beans, string, 13.63 pounds (82); cabbage, 26.13 pounds (84); cabbage, 
boiled, 5.94 pounds (85); leeks, 1.56 pounds (93); lettuce, 7.06 pounds (94); onions, 
6.81 pounds (96); potatoes, 198.38 pounds (99); corn, canned, 2.06 pounds (109); 
tomatoes, canned, 22.75 pounds (111); pickles, cucumber, 0.25 pound (114) 

Fruits: Lemons, 1.56 pounds (117); strawberries, 26.63 pounds (120); grapes, pre- 
served, 0.75 pound (128); pears, canned, 26 pounds (127) 

Beer,o 6 pounds (134) 

Olive oil, 0.63 pound (135) 



Total vegetable food. 
Totalfood 



FOOD UNCONSUMED. 



Food unused at end of study: Ham, smoked and boiled, 1.44 pounds (24); codfish 
cakes, 0.50 pound (137); fat, 5.19 pound (46); bread, 11.31 pounds (66); noodles, 
2.06 pounds (63) 

Waste: Bread, 1.63 pounds (66); table waste, 148.50 pounds (142); kitchen waste, 
79.13 pounds (141) 



Total food unconsumed . 
Total food consumed. . . 



Grams. 
14.1 
6.4 
3.8 
6.3 
5.4 
4.9 
1.1 
8.1 



Calories. 

133 
46 
46 

168 

128 
22 
13 

487 
65 



50.1 



25.2 



6. 

.4 



31.6 



81.7 



1.9 

6. 3 



S. 2 



r3.5 



1,108 



248 



205 



1,382 



2,490 



172 

265 

2,225 



a A donation sufficient in amount for only a portion of the inmates. 
WASTE. 

The food wasted in this study was weighed in three forms: (1) A 
lot of bread weighing 1 pound 10 ounces thrown away as too dry to 



62 

use; (2) table waste weighing 148 pounds 8 ounces; and (3) kitchen 
waste weighing 79 pounds 2 ounces. The protein and energy wasted 
was only about 7 per cent of the total, a very creditable showing. 

Most of the waste seemed unavoidable. Of course the bread could 
have been utilized if attended to in time, but this was a very small 
item and there is no reason to suppose it other than an accidental oc- 
currence. On the whole, very great pains were evidently taken to 
reduce the waste to a minimum, and, as the data show, with com- 
mendable success. It should also be noted that the waste in this home 
was not thrown away as garbage, but used as food for the flock of 
hens and incidentally gave some return in this way. 

On the other hand, there existed another probable source of waste 
which could not be measured. It was the custom to allow the inmates 
to take tea and coffee to which milk and sugar had been added to their 
rooms to be consumed when desired. Occasionally inmates were seen 
to take other foods from the table for the same purpose. It is not 
reasonable to suppose that all of this food was eaten. At the same 
time the waste was probably greater in bulk than in nutrients, as the 
tea and coffee contained only small amounts of actual food. While 
it could easily have been avoided altogether by doing away with the 
practice, it is a question for the management to decide whether or not 
this would be wise. The custom is said to be in accordance with the 
habits of many of the inmates prior to admission to the home and its 
abolition might arouse discontent. Quite likely the slight loss was 
justified as a means of making the inmates more contented. It is in- 
teresting to note that in Swedish old-age homes a it is the custom to 
allow the inmates to prepare their own breakfast (coffee and bread) 
and their afternoon coffee in their rooms, a practice in accord with 
their usual habits, and believed to contribute to their contentment and 
comfort without adding materially to the expense of the institution. 

ADEQUACY OF THE DIET. 

According to the table (p. 61) the protein and fuel value of the 
food actually eaten per male inmate per day during this study was 
73.5 grams of protein and 2,225 calories of energy. This amount of 
energy is practically identical with the standard, 2,200 calories, but 
the protein is over 10 grains lower than the 85 grams which the stand- 
ard calls for. Since in the calculations of this study the female in- 
mates are considered as consuming only 0.8 of the food consumed by 
the males, and since it is doubtful whether in extreme age the food 
consumption of the sexes differs as much as this implies, the figures 
here, if they err at all, are too large rather than too small. Neverthe- 
less, bearing the extreme age and light weight of the inmates in mind, 

a Littell's Living Age, 7. ser., 17 (1902), p. 473. 



63 

it does not necessarily follow that the diet was inadequate, even as re- 
gards protein. They were not restricted as to the amount of food 
eaten at table and could have increased it had they wished. More- 
over, many of them seemed to have private sources of supply through 
individual purchase or gifts. The observer several times noticed in- 
mates bringing in food, and the table waste during the study con- 
tained 10 ounces of prunes, an orange, and several ounces of pretzels, 
none of which were provided by the home. It was of course quite im- 
possible to estimate the amount of food thus obtained, but probably it 
introduced no large error, especially as it seemed to consist mainly of 
succulent fruits and other materials of low nutritive value in pro- 
portion to their bulk. Just as in the previous studies, it may have 
been simply the desire for variety which prompted the inmates to 
procure such extra food ; nevertheless its existence must be considered 
in discussing the adequacy of the diet. But even making allowance 
for it, this study, like that in the aged men's home, suggests that 
persons in extreme age can be comfortably nourished on less protein 
than the 85 grams indicated by the standard. 

COST AND SELECTION OF FOOD. 

According to the report of the home for 1906, the cost of food ma- 
terials for that year was $3,016.45, and the number of inmates and 
attendants about 70, making the average cost per person about 83 
cents a week, or about 12 cents a day. The institution is to be con- 
gratulated upon its judicious expenditure; the cost was only about 
half as great as in the aged women's home and aged men's home, 
and this in spite of the fact that the German home received few gifts 
of food. The amount of nutrients provided was somewhat less, but 
the inmates seemed contented and well nourished. Unless one is to 
question the advisability of so low a protein supply, which would 
seem, however, entirely adequate for aged persons with little or no 
activity, criticism is useless in the face of so good a showing. Two or 
three peculiar features of the management may, however, be of in- 
terest to those having charge of similar dietaries. 

The menus for the week showed that the suppers were very simple 
and lacking in variety, while the dinners were much more varied. 
This is said to be in accordance with a common German custom. 
No butter was served at noon except on Sunday. A peculiar system 
was in vogue as to vegetables; a larger quantity than was necessary 
for a single meal was cooked, and the surplus warmed over on the 
following day and served in smaller quantities. By following this 
custom two vegetables were obtained for each dinner, although but 
one had really been purchased for that meal. This permitted greater 
catering to individual tastes than would otherwise have been the 
case, and was appreciated by the inmates. 



64 

DIETARY STUDY NO. 689. 

This study was made at the Maryland Home for Friendless Colored 
Children. During the year 1906 the institution received $1,065.40 
from the city of Baltimore and $500 from the State of Maryland. 
There was a further very small income from board paid by a few 
children. Considerable dissatisfaction had been expressed by the city 
board of charities regarding the management of the home and radical 
changes had just been made to avoid the loss of the city appropria- 
tion. It had been very recently moved from a less desirable part of 
the city to its present location, and its policy had been altered. It 
had formerly received both boys and girls, but henceforth was to re- 
ceive boys only. At the time of the study there were still 2 girls, who 
were to be removed as soon as desirable arrangements could be made, 
and 23 boys. The ages of the children ranged from 3 to 13 years. 
The care of the home and children was in the hands of a matron and 
two assistants, all colored. Definite information on some points was 
difficult to obtain, as the institution published no report. 

The building was a well-located, three-story brick house, part of 
a city block, and large enough to accommodate from 20 to 30 children. 
There was a small yard in the rear. The dining room was a dark, 
back room only 12 feet square ; into this were crowded two tables, seat- 
ing, respectively, 12 and 13 children, a smaller one for the matron, and 
a refrigerator. The kitchen was immediately behind the dining room 
and contained few conveniences. 

PURVEYING OF FOOD. 

The institution depended for its food largely upon donations, 
which came in very irregularly. The staple food was stale bread, 
which was secured each day from local bakers. The materials which 
were bought were obtained rather at haphazard. Some foods were 
purchased in very small quantities — for instance, potatoes, on one 
occasion, were bought by the quart. On the other hand, a 200-pound 
bag of salt was found in the pantry, and both granulated and brown 
sugar were bought by the barrel, although very little of the granu- 
lated was used. Corned beef, bacon, hominy, and flour were also pur- 
chased in large quantities. There were considerable donations ol 
cake, cookies, pies, and occasionally fruit. It may be noted that the 
tea served at all the tables was very weak, 1 teaspoonful of leaves 
sufficing for a meal. Most of the 15 quarts of milk used during the 
week were mixed with the tea. In general, it may be said that no 
systematic attention was given to the food supply, although a weekly 
menu was found posted in the kitchen, presumably as a guide in 
serving meals. 



65 



KINDS OF DIET. 

The matron and her assistants ate at the same time as the children, 
but had a much more varied diet, including considerably more meat, 
vegetables, and fruit. These items are separately listed in the table 
(p. 67) and include the greater part of the materials purchased. One 
of the children was ill with measles during the study and received a 
special diet for most of the week. 

AGE 5 WEIGHT, AND PHYSICAL CONDITION OF CHILDREN. 

The following table gives the statistics gathered on these points. 
The only scales available for weighing the children were in a penny - 
in-the-slot machine near by. Several rough tests of the accuracy of 
this were made which indicated that its readings were reasonably 
correct, and the weights here given are considered fairly reliable. 

Ages and weights of negro orphans. 



Subject. 



Boy 

Do 

Do 

Do 

Girl (probably tuberculous) 

Boy 

Girl 

Boy 

Do 

Do 

Do 

Do 

Boy (probably tuberculous) 
Boy 



Age. 



Years. 
3 
3 
5 
5 
6 
7 
7 



Weight. 



Pounds. 
39 
41 
38 
41 
37 
48 
54 
45 
54 
56 
56 
59 
50 
62 



Subject. 



Bov 

v Do 

Do 

Do 

Do 

Do 

Do 

Do 

Do 

Do 

Boy (only one leg) 

Average 



Age. 



Years. 
10 
10 
10 
10 
10 
11 
11 
11 
12 
12 
13 



8.7 



Weight. 



Pounds. 
56 
58 
75 
76 
78 
70 
74 
77 
68 
85 
68 



58.6 



These figures seem slightly below the average for children of the 
respective ages, but the difference is not marked, especially in the 
older boys. The table of* weights for different ages, as given by one 
of the large life insurance companies, is as follows : 



Average weight of hoys and girls at different ages, as shoivn 

statistics. 



insurance 



Subject. 


Age. 


Weight. 


Boy. 


Girl. 


Child 


Years. 
5 
6 
7 
8 
9 

10 
11 
12 
13 


Pounds. 
45 
50 
55 
57 
62 
67 
72 
78 
85 


Pounds. 
40 


Do 


43 


Do 


47 


Do 


52 


Do 


57 


Do 


62 


Do 


69 


Do 


78 


Do 


89 







66 

It should be said in this connection that probably the figures in the 
second table apply to children with more or heavier clothing. The 
orphans here studied went barefooted, and the clothing of the boys 
consisted simply of a shirt and pair of trousers. This would prob- 
ably make a difference of at least 1 or 2 pounds in the weight. 

In general, the children seemed in good health and spirits and 
showed little sign of underfeeding. Two, however, were in delicate 
health and seemed to the observer to be suffering from tuberculosis. 

The following menu for one day, June 17, gives an idea of the 
kind of meals served. 

Menu for Wednesday, June 17, 1906. 

Breakfast: Bread, rolled oats, milk, brown sugar. 
Dinner : Bread, corned beef, green peas, boiled cabbage. 
Supper : Bread, molasses, brown sugar, cookies. 

ATTENDANCE. 

The study began with supper on June 14, after a preliminary ob- 
servation of half a day, and continued through 21 meals. The total 
attendance for the week was 483 meals for boys, 42 for girls, and 62 
for the matron and attendants. As has been pointed out, the diet at 
the matron's table was made up in part of that eaten by the children, 
but supplemented to a very large extent by additional materials. It 
is believed to be a fair assumption that the matron and her assistants 
ate the same amount of the regular diet as did the children and that 
the amounts of additional foods may be considered as compensating 
for the difference in age and activity. The girls were so young that 
it is not believed that their food consumption need be estimated sepa- 
rately from that of the boys. In other words, the entire attendance, 
587 meals, equivalent to 1 child for 196 days, may be considered as 
the basis for computing the amounts " per child per day." 

A means of verifying this assumption, however, is afforded by the 
supplementary list of foods eaten at the matron's table, as given at 
the end of the table on page 67. The nutrients in this, when divided 
by 3, the total number of women receiving these foods, and added 
to the amounts of protein and energy supplied per child per day give 
a total of 93.7 grams protein and 2,495 calories of energy, an ample 
ration for a woman at light to moderate muscular work. 



67 



Weight of total food and protein and fuel value of food per child per day, 

dietary study No. 689. 



Kind and weight of food materials. 



Amounts per child 
per day. 



Protein. 



Fuel 
value. 



ANIMAL FOOD. 

Beef: Shoulder and clod, 5.13 pounds (6); corned, 10.38 pounds (12). 

Pork: Backs, dry-salted, 5.63 pounds (27) 

Fowl, 5 pounds (34) 

Eggs, 2.81 pounds (41) 

Dairy products: Butter, 2.13 pounds (42); milk, 29.50 pounds (44).. 
Lard, 2.75 pounds (47) 



Total animal food . 



VEGETABLE FOOD. 

Cereals: Hominy, 4.75 pounds (51), boiled, 3.13 pounds (52); oats, rolled, 4 pounds 
(53); rice, boiled, 3.75 pounds (56); wheat flour, 11.69 pounds (60); biscuit, Mary- 
land, 10.56 pounds (67); bread, white, 124.94 pounds (66); rolls, 1.44 pounds (68): 
cake, baker's, 10.31 pounds (72), frosted, 1.13 pounds (73); pie, rhubarb, 2.25 
pounds (74) 

Sugar, etc.: Molasses, 7.88 pounds (77); sugar, brown, 11.56 pounds (78) 

Vegetables: Cabbage sprouts, 2 pounds (86); carrots, 0.63 pound (87); carrot tops, 
2.19 pounds (88); onions, 0.38 pound (95); peas, green, 1.13 pounds (98); pota- 
toes, 4.44 pounds (99); potatoes, boiled, 5.25 pounds (101); rhubarb, 3.63 pounds 
(102); squash, 7.06 pounds (106); tomatoes, canned, 2.13 pounds (111) 



Total vegetable food. 
Total food 



Table and kitchen waste, 3.19 pounds (143). 
Soup, 15.25 pounds (136) 



Total waste 

Total food consumed. 



SPECIAL FOOD SERVED AT MATRON'S TABLE. 

Animal food: Beef, round, 4.69 pounds (4); lamb, leg, 2.50 pounds (16); pork, loin, 

1 pound (21); pigs' feet, pickled, 1.38 pounds (28) 

Vegetable food: Macaroni, 0.88 pound (63); rice, flaked, 0.19 pound (57); sugar, 

granulated, 1.69 pounds (79); cucumbers, 0.56 pound (90); leeks, 1.50 pounds (93); 

lettuce, 0.38 pound (94); tomatoes, 0.88 pound (107); bananas, 3.38 pounds (115); 

blackberries, 1.25 pounds (116) 



Total special food per woman per day « . 
Total food per woman per day a 



Grams. 
6.1 
1.0 
2.2 
.8 
2.3 



36.7 
.4 



4.5 



43.5 



93.7 



Calories. 
95 
92 
27 



1,154 
156 



1.4 


41 


38.5 


1,351 


50.9 


1,721 


.4 
.3 


11 
33 


.7 


44 


50.2 


1,677 



315 



818 



2,495 



a See page 65. 



WASTE. 



The normal waste in this home was very small, amounting for the 
whole week to only 3 pounds 3 ounces. In fact, it proved easier to 
save and analyze all the waste than to sample it. The greater part, 
indeed, came from the matron's table; there was rarely anything 
but a few crumbs discarded by the children, and the kitchen waste 
consisted largely of the ends of loaves of bread. 

Besides this usual waste, however, there were two losses due to 
negligence. The first was in the case of fresh cabbage, which was 
kept so long that the outer leaves had to be discarded. This was 
included with the regular waste. The second case was more notice- 



68 

able. About 35 pounds of chicken bones, from which most of the 
meat had been removed for salad, was donated by a caterer. A por- 
tion of this was given to the children immediately, but the remainder 
was made into soup and doled out gradually. Part of this was kept 
until it became unfit for food, and 15.4 pounds had to be thrown away. 
This of course involved a waste of the other materials in the soup as 
well as of the chicken itself. Even so, some soup was eaten after it 
had spoiled, and several of the children were made ill by it. 

ADEQUACY OF THE DIET. 

This topic will be discussed at length in a later section (see p. 87). 
Suffice it here to say that as compared with the dietary standard 
usually accepted in this country, the daily supply of protein, 50.2 
grams, and the fuel value of the daily food, 1,677 calories, are both a 
trifle low. It may well be, however, that an investigation of the diet 
at another time would have found it more generous. 

As was previously stated, most of the children had the appearance 
of fair health. They were always eager for more to eat, a boy on 
one occasion even eating the crumbs of table waste which had been 
gathered up after the meal, but such a state of things is too common 
among children generally to be of great significance. The children 
were forbidden to get food of any kind outside of the home, and it is 
not probable that they often obtained anything except a very little 
candy in this way. Judging from their rather low weights, they were 
none too well nourished. If we accept the general belief that an 
abundant diet, especially as regards protein, is necessary for the best 
development of a growing child, then the protein supply as shown 
by the period of the present study must be considered somewhat too 
low for the best results. 

COST AND SELECTION OF FOOD. 

No data are available as to the cost of this diet, but as it was prac- 
tically all donated, the cash expenditure must have been very small. 
Since the orphans were fed so largely on whatever was available, dis- 
cussion of its improvement seems futile. The question of the extent 
to which charitable institutions should solicit or even accept gifts of 
food, however, is a very broad one. After all, this home was merely 
an extreme type of what took place to a limited degree in all the Balti- 
more homes visited except the German Aged People's Home. Prob- 
ably to a certain extent the system may be justified. So long, however, 
as people continue to give away what is of little value to themselves 
we should not expect foods of the best quality or suitability to be thus 
provided. An institution supplied with the equivalent in money 
would be able to expend its funds to much better advantage and in 



69 

addition be in a position to provide a systematic and well-ordered 
diet such as can not be obtained when the food supply is so largely the 
result of chance. 

DIETARY STUDY NO. 690. 

The last study of the series was made at the German Orphan 
Asylum (Allgemeines Deutsches Waisenhaus), a charitable institu- 
tion in the northeastern part of Baltimore. It had a small endow- 
ment and receives $1,500 a year from the State, but was chiefly sup- 
ported by the subscriptions of German-American residents of the city, 
from whom the board of management was also drawn. Although 
there were no restrictions as to the nationality of the orphans ad- 
mitted, they were almost exclusively of German parentage. The 
immediate supervision of the asylum and children was in the hands 
of a superintendent and of his wife, who served as matron, and three 
teachers. A baker, a tailor, a shoemaker, and a cook, all Germans, 
were also employed, but the greater part of the housework was done 
by the older girls. 

The neighborhood in which the asylum is located was a good one 
when the institution was established, about thirty years ago. It had 
recently, however, become very crowded and undesirable, and the 
management contemplated removing the asylum to the suburbs. The 
building was a large, detached four-story brick structure, with about 
an acre of playground in the rear. The house accommodated 165 
children, and that number was enrolled at the time of the study, 
though about 40 of the youngest had been sent to a branch home in 
the country for the summer. The extensive storerooms and the bakery 
where the bread and pastry are made were in the basement. The 
general kitchen was a good-sized room on the first floor, and was 
equipped with a large modern range and many improved labor-saving 
devices. The main dining room, adjoining the kitchen, was a large, 
well-lighted room, with five long tables, seating from 11 to 36 children 
each. The tables and dining room floor were scrubbed after each 
meal. Meal hours for the children were 7.30 a. m., 12.15 p. m., and 
6 p. m. 

PURVEYING OF FOOD. 

Particular attention was given in this institution to buying ma- 
terials in bulk, and cereals, canned goods, apple butter, sirup, sugar, 
sauerkraut, potatoes, etc., were always obtained in that way. The 
food purchased was of good quality. The only dissatisfaction during 
the study was caused by the milk, which was obtained direct from a 
farmer ; it did not keep well and was suspected to be of poor quality. 
The question was referred to an inspector of the city health depart- 
ment, who took samples for analysis. Besides the food purchased, the 



70 

asylum received frequent gifts of meats, bread, cake, vegetables, and 
fruit. There is no means of knowing how large a proportion of the 
diet during the study was obtained in this way. Shrewd management 
and good business judgment were everywhere manifested in this 
home, as were also neatness and thrift. 

KINDS OF DIET. 

Four different diets were served during this study: (1) The super- 
intendent's private table, at which meals were served to all the adults 
and the superintendent's two children immediately before the orphans 
were served. Special meats and vegetables were always provided for 
this table, though not necessarily more expensive kinds. The other 
foods were mainly of the same kind as those for the regular table. 
Articles used exclusively for this table are so designated in the table 
(p. 73). (2) Working girls' table, for the 11 oldest girls, who had 
regular household duties. Their fare consisted of the regular diet, 
supplemented at dinner by coffee, with milk and sugar, and at sup- 
per by fried potatoes and some kind of meat, usually cold. (3) Ta- 
ble for children under 8 years old, of whom there were only six at 
the time of the study. They had the regular diet, with milk at each 
meal, and no tea or coffee, (i) Regular table for all other children. 
A sample menu of this group for the week studied is given on page 71. 

AGE, WEIGHT, AND PHYSICAL CONDITION OF CHILDREN. 

The statistics regarding the age and weight of the boys and girls in 
the asylum are shown in the following table: 

Age and iceight of children, dietary study No. 690. 



Age of 
children.** 


Number of 
boys. 


Average 

weight of 

boys. 


Number of 
girls. 


Average 

weight of 

girls. 


Years. 
4 


1 
1 


Pounds. 
31.0 
37.0 




Pounds. 


5 






6 






7 


1 
3 
3 
6 
8 

10 

17 

7 

1 


43.0 
48.0 
49.3 
51.5 
51.9 
61.4 
64.4 
70.3 
107.0 


3 
2 
9 
6 
7 
3 
6 
4 
6 
7 
4 


42.7 
54.5 
51.9 
52.7 
61.0 
64.7 
74.3 
93.7 
99.7 
105.6 
109.5 


8 


9 


10 

11 

12 

13 

14 

15 

16 


17 






Total 

Average.. 






58 




57 




59.2 


74.3 









a Average age : Boys, 11.5 ; girls, 12.2 years. 



Comparison with the figures published by one of the large life 
insurance companies and with the weights of negro children in the 



71 

preceding study (see p. 65) shows that while these children weighed 
a little more than the negro orphans their weights were considerably 
lower than those given by the insurance company. It should be re- 
membered that these studies were made in June, in a warm climate, 
and the clothing worn would probably weigh considerably less than 
that of the average child under other circumstances. Low weights 
were more noticeable among the boys than the girls, and especially 
among the older boys. The observer was surprised to learn the ages 
of the larger boys, as he had supposed them well-developed boys 
several years younger than they actually were. The low weight 
among those over 12 years of age may be partly explained by the 
fact that after reaching that age the boys were frequently appren- 
ticed, and those remaining in the asylum would represent the least 
robust. In general, the children appeared in excellent health, and 
the institution had an unusually good record in this respect. During 
the week of the study there was but one case of sickness among 120 
children, and in the fifteen years in which the superintendent had 
been in charge there had been but three deaths in the asylum. 

The following menu for one day is given as a sample of the diet 
served at the regular table during the study : 

Menu for June 23, 1906. 

Breakfast : Bread, with apple butter, coffee, and rolled oats with milk and 
sugar. 

Dinner : Bread, rice boiled, potatoes boiled, prunes stewed. 
Supper : Bologna sausage, bread, tea with milk and sugar. 

ATTENDANCE. 

On account of the necessity of completing the study before June 
30, the end of the fiscal year, the preliminary period of observation 
was omitted. The study began with dinner on June 22 and was con- 
tinued through 21 meals. The number of meals served during this 
time was: To. men, 89; to women, 121; to girls, 1,181; to boys, 1,208, 
a total of 210 to adults and 2,389 to children. 

The computation of the amounts eaten per person per day in this 
study is somewhat complex, as the population included adults and 
children of both sexes and of various ages and duties. The men, 
namely, a superintendent, baker, tailor, and shoemaker, all assisted 
in looking after the boys at various times, in addition to their other 
duties. The women were the matron, the aged mother of the super- 
intendent, the cook, and three teachers. The older boys were being 
taught baking, tailoring, and shoe repairing in the home, and the 
older girls were quite actively engaged in the kitchen and laundry. 
The younger children attended school when in session, but at the 
time the study was made it was vacation and they had no regular 



72 

duties. Further, as has been already explained, four different diets 
were served regularly (see p. 70). 

Two special difficulties were also encountered. The first was the 
absence of 74 children and 2 teachers from dinner on the sixth day 
of the stud}- , because of a picnic. A lunch of sandwiches of cheese 
and cold ham and beef, and rolls, was prepared at the home and taken 
along ; hence it could not be assumed that the picnickers were absent 
from any meals. Many of them, however, bought, in addition to 
this lunch, peanuts, popcorn, ice cream, etc., in unknown amounts, 
so that while the sandwiches could not have been equivalent to the 
dinner usually served, the • appetites of these children were noticed 
to be very small at supper and much less than the usual amount of 
food was eaten at that time. 

The second difficulty was encountered on the day following, which 
was the monthly visiting day. On this occasion it is the custom for 
relatives and friends to bring to the individual children fancy cookies, 
cake, fruit, etc., and the total amount thus brought in was quite con- 
siderable. In the opinion of the observer each child must have had 
at least the equivalent of one banana and one cookie, although owing 
to the varied character of the gifts the exact kind and amount could 
not be ascertained. It seems, however, safe to assume that this error 
and the one due to the picnic together make the equivalent of per- 
haps one meal for each child, but it was not deemed wise to regard 
this in the calculations. In view of all the sources of uncertainty, the 
accuracy of this study is probably not so great as that of the others, 
and this must be kept in mind in drawing deductions from the work. 

An attempt has been made to make the calculations in two ways, 
so that each may act as a check on the other. To obtain the figures 
given in the table on page 73 it was assumed that the food consump- 
tion of the adults was 1.5 that of the children ; the number of meals 
for adults, 210, was multiplied by 1.5, making 315, which, added to 
those for children, 2,389, gives a total of 2,704, equivalent to 1 child 
for 901 days. This method assumes that the adults were at light to 
moderate muscular work, and that the children were from 10 to 12 
years of. age. a While the figures are not absolutely accurate, the 
error introduced can not be large. 

As a check to these calculations the total amount of protein and 
energy consumed during the entire week by the whole population 
(58,700 grams of protein and 1,620,700 calories of energy) was 
taken and from this were deducted the amounts eaten by the adults, 
assuming that each man consumed 112 grams protein and 3,050 
calories of energy, and each woman 90 grams protein and 2,450 
calories of energy per day. 6 As there were 89 meals for men, or 1 

°TJ. S. Dept. Agr., Farmers' Bui. 142, p. 33. 
6 U. S. Dept. Agr., Farmers' Bui. 142, p. 35. 



73 

man for thirty days, and 121 for women, or 1 woman for forty days, 
these amounts are 3,360 grams protein and 91,500 calories of energy, 
plus 3,600 grams protein and 98,000 calories of energy, or a total of 
6,960 grams protein and 189,500 calories of energy. The results 
obtained after this subtraction were divided by 796 (or 2,389-^-3), 
which is the equivalent number of food days for 1 child. This sec- 
ond calculation gives the amounts consumed per child per day as 65 
grams of protein and 1,798 calories of energy, practically identical 
with the 65.1 grams of protein and 1,798 calories of energy obtained 
by the first method. 

Weight of total food, and protein and fuel value of food per child per day, 

dietary study No. 690. 



Kind and weight of food materials. 



Amounts per child 
per day. 



Protein. 



Fuei 
value. 



ANIMAL FOOD. 

Beef: Ribs, 22.50 pounds (2); roast,a 0.69 pound (9); rump,« 12.19 pounds (5); 

shoulder andclod, 45.75 pounds(6); steak, Hamburg^ 9.63 pounds (11) 

Veal, leg, 27.69 pounds (14) 

Mutton, leg, 10 pounds (17) 

Pork: Rib, 30 pounds (19); side, cooked, a 0.56 pound (22); ham, smoked, salted, 

and boiled, 18.88 pounds (24) 

Sausage: Bologna, 20 pounds (30); liver, 15.56 pounds (32) 

Eggs, 15.13 pounds (41) 

Dairy products: Butter, 7 pounds (42); cheese, full cream, 10.38 pounds (43); milk, 

650.63 pounds (44) 

Lard, 15.44 pounds (47) • 



Total animal food . 



VEGETABLE FOOD. 

Cereals: Barley, pearled, 9.25 pounds (49); oats, rolled, 31.50 pounds (53); rice, 15 
pounds (55); wheat flour, 299.56 pounds (60); bread, wheat, 139 pounds (66); bread, 
wheat and rye, 16.25 pounds (69); cake, bakers', a 1 pound (72) 

Sugars: Brown, 30.50 pounds (78); granulated, 39.56 pounds (7) 

Vegetables: Beans, strings 2,56 pounds (82); beets, a 3.63 pounds (83); cabbage, 41.88 
pounds (84); cabbage, boiled, 7.56 pounds (85); cucumbers,a 3.13 pounds (89); 
kohl-rabi,o 3.88 pounds (92); lettuce, a 3.25 pounds (94); onions, a 1.19 pounds (96); 
peas, dried, 20.50 pounds (97); potatoes, 126.69 pounds (99); rhubarb, a 2.25 pounds 
(101) ; sauerkraut, 14.06 pounds (104); beans, baked and canned, 50.25 pounds (108); 
beans, string, pickled, 17.25 pounds (112) 

Fruit: Lemons, a 1.75 pounds (117); pineapple, « 8.25 pounds (119); prunes, 10.31 pounds 
(123); peaches, canned, 6.13 pounds (126); jelly, currant, 13.38 pounds (130) 

Apple butter, 19.94 pounds (133) 

Beer, a 11 pounds (134) 

Olive oil,a 2.38 pounds (135) 



Total vegetable food . 
Total food 



FOOD UNCONSUMED. 

Food unused at end of study: Beef, rump, cooked, 1.50 pounds (10); fat, 1 pound (46); 

beets, pickled, 1 poimd (113) 

Waste, 104.44 pounds (144) 



Total food unconsumed . 
Total food consumed 



Grams. 
8.8 
2.9 



4.6 

2.8 



12.2 



34.1 



67.2 



2.1 



65.1 



Calories. 

119 

21 

12 

83 
47 
11 

285 
72 



650 




1,210 
1,860 



G2 



1,798 



a Served only at superintendent's table. 



74 

WASTE. 

The total amount of food wasted in this study was 104 pounds 7 
ounces, containing about 3 per cent of the total protein and energy 
of the food. This proportion is very small, especially when it is re- 
membered that the subjects were children, and it is well known that 
children often show a tendency to leave food uneaten. In the pres- 
ent study this rarely occurred. This may- be partly explained by the 
rule requiring them to eat whatever they took on their plates, but the 
observer noticed furthermore that very little food was returned from 
the dining room to the kitchen from the large dishes in which it was 
served, or, in other words, that the total amount served at each table 
was consumed. Exceedingly good judgment as to the amount likely 
to be eaten probably explains this. Moreover, the fact that on the 
evening of the picnic and visiting days, when the appetite had been 
satisfied by extra food, food was left both on the serving and indi- 
vidual plates affords a strong corroboration of the supposition. 

All waste from the plates was thrown away as garbage. When sur- 
plus meats and similar materials remained in the serving dishes, 
they were utilized at the table of the larger girls. In general, efforts 
to reduce waste of every sort were manifest. 

ADEQUACY OF THE DIET. 

In spite of the discrepancies discussed above, the amounts per child 
per day given in the table (p. 73) are probably sufficiently correct 
to be used as a general basis of discussion, which will be given be- 
yond (see p. 87). 

It may be briefly stated here that the protein and energy of the 
diet were about equal to those suggested by the commonly accepted 
standard for boys of 11 and girls of 12 years of age, whereas the chil- 
dren's ages averaged a few months higher. When we consider that 
on the average they were under normal weight, it becomes a question 
whether a slightly more liberal diet would not be desirable. At the 
same time it must be admitted that the children appeared healthy 
and comfortable on the food supplied. 

COST AND SELECTION OF FOOD. 

The report of the asylum for the year 1906 gives the cost of food 
as $4,462.59 and the number of children as 153, indicating an average 
cost of 56 cents per child per week, or 8 cents a day. Many of the 
materials used were donated, especially the more expensive kinds, so 
that these figures do not represent the actual cost of the total food 
used. It is impossible to say how much should be added for the 
donations, but it must certainly be a noticeable amount. Even mak- 
ing due allowance for this, there is every reason to believe that the 



75 

money spent for food was not at all excessive and brought a good 
return to the institution. 

As in the German Aged People's Home, the breakfasts and suppers 
were very plain and monotonous, and the dinners much more varied, 
and this arrangement, while not in accord with the usual custom in 
this country, seemed acceptable to the inmates and is said to be in ac- 
cord with German custom. Aside from this point, the diet in this 
asylum had no striking features and seemed chosen with economy and 
wisdom. 

THE DIETARY STUDIES WITH THE AGED AND THEIR RESULTS. 

DIETARY REQUIREMENTS OF THE AOED. 

Temperament and other factors undoubtedly have an effect upon 
the amounts of food consumed by individuals, but, considering aver- 
age values and uniform body weight, it is generally conceded that 
the most important factors in determining food requirements are 
age, sex, and muscular activity. The commonly accepted American 
dietary standards assume that a woman requires eight-tenths as much 
protein and energy as a man performing a like amount of muscular 
work of the same degree of intensity; that children require smaller 
quantities than adults ; that their requirements increase until they are 
fully grown ; and, in general, that food requirements are directly 
dependent upon the amount of muscular work performed. Data 
regarding the effects of age have been limited, and the standards 
referred to have not given factors for middle life and old age, though 
it is generally recognized that after man has reached maturity and 
the development of his powers there is a natural physical decline, and 
many writers on dietetics have insisted that there is a corresponding 
decline in food requirements. 

The literature regarding the relations of old age to tissue metabo- 
lism, cell activity, and related topics is fairly large, but no attempt 
is made to review it thoroughly here. Some of the more interesting 
studies, however, will be briefly referred to in the following para- 
graphs and their results given in the table on page 83. 

Cornaro, an Italian who published a treatise on the subject in the 
sixteenth century, is often cited as an example of the advantages to 
be derived from a diet simple in character and restricted in amount. 
According to his own statement," when 35 to 40 years of age, he be- 
came very ill as a result of excesses of all kinds and was advised by 
his physicians to change his habits and to observe great moderation 
in food, drink, and all things. After more or less experimenting with 
foods and drinks to ascertain whether those which pleased the palate 

°A Treatise of Temperance and Sobrietie. Translated by G. Herbert [First 
Italian edition appeared in 1558.] 



76 

also agreed with him, he gave up his former excesses and regained 
his health, living a regular life for many years. He paid great atten- 
tion to exercise in the open air, to sleep, to wholesome pleasures, and 
all other things which make for health as much as does diet. In his 
first essay, written when he was' 83 years old, he gives some details 
regarding his food habits, stating that when 78 or 79 his daily fare 
consisted of 12 ounces of bread, egg yolk, broth and meat, and 12 
ounces of wine. Whether these amounts are the same as he con- 
sumed when younger is not stated. However, in one of his essays 
he says that as he advanced in years and lost strength he felt that 
he should lessen rather than increase the quantity of food eaten, so it 
is not improbable that his diet in the years immediately following the 
change in his manner of living was more generous than in old age. 
In speaking of the foods which he used when 86 years of age, Cor- 
naro mentions veal, kid, mutton, eggs, bread, porridge, broth, chicken 
and other poultry, wild birds, and fish, but there is nothing said of 
the amounts eaten. The fact is so clearly recognized by Cornaro that 
food requirements diminish as a person grows old that it seems fair 
to conclude that he modified his diet in accordance with this view and 
that his experience may be regarded as an excellent illustration of the 
advantage of great moderation in advancing years. 

Lessius, a a writer on dietetics of a little later date than Cornaro, 
expresses very similar views regarding food requirements in later 
life. He states clearly that labor very largely determines the food 
requirements for persons of like age, and that old persons require 
smaller amounts than the young or middle aged. In his opinion, the 
diet of the aged should consist of bread, meat, eggs, and such foods, 
the total daily quantity ranging from 12 to 14 ounces. Other early 
writers could be cited in support of this belief. 

Most of the recent writers, including such authorities as Voit, 6 
Munk and Ewald, c and Sir Henry Thompson,** may be cited in sup- 
port of the theory that those who have passed middle life do not 
require as much food as the young. 

Sir Henry Thompson sums up the matter thus: 

As we increase in age — when we have spent, say, our first half century — less 
energy and activity remain, and less expenditure can be made; less power to 
eliminate is possible at 50 than at 30, still less at 60 and upward. Less nutri- 
ment, therefore, must be taken in proportion as age advances, or rather as 
activity diminishes, or the individual will suffer. If he continues to consume 

a Hygrasticon, or the Right Course of Preserving Life and Health unto 
Extreme Old Age. Cambridge, 1634. 

6 Ztschr. Biol., 12 (1876), p. 32. 

c Erniihrung des gesunden und kranken Menschen. Vienna and Leipsic, 
1895, pp. 72, 214. 

d Diet in Relation to Age and Activity. London and New York, 1902. 



77 

the same abundant breakfasts, substantial lunches, and heavy dinners, which at 
the summit of his power he could dispose of almost with impunity, he will in 
time certainly either accumulate fat or become acquainted with gout or rheuma- 
tism, or show signs of unhealthy deposit of some kind in some part of the 
body * * * which must inevitably empoison, undermine, or shorten his 
remaining term of life. He must reduce his " intake," because a smaller ex- 
penditure is an enforced condition of existence. At 70 the man's power has 
further diminished and the nutriment must correspond thereto, if he desires still 
another term of comfortable life. And why should he not? Then at 80, with 
less activity, there must be still less " support." 

Moderation is the keynote of the advice which he gives regarding 
diet suited to middle life and old age. 

The great practical rule of life in regard to human diet will not be found in 
enforcing limitation of the sources of food which nature has abundantly pro- 
vided. On the contrary, that rule is fulfilled in perfect development of the art 
of adapting food of any and every kind to the needs of the body according to 
the very varied circumstances of the individual, at different ages, with different 
forms of activity, with different inherent personal peculiarities, and with dif- 
ferent environments. 

He conformed his own habits to his beliefs regarding moderation 
in diet and in all things, and lived to be over 80 years of age. 
Special attention was paid to moderate exercise in the open air and 
to other matters of hygiene. He advises a dietary system which he 
states can be varied according to the idiosyncrasies of the individual. 
This includes four small meals per day, namely, breakfast about 
8.30, luncheon at about 1, dinner at 7, and a light supper at about 11. 
The animal food recommended for breakfast and luncheon includes 
egg or fish. A little meat or fowl may be taken at luncheon, unless 
it is preferred to reserve them for dinner, in which case fish and a 
farinaceous pudding may be substituted. The dinner he recom- 
mends includes a little consomme, puree of fish or soup, and a little 
fowl or game, with a dish of vegetables, and finally some light 
farinaceous pudding with or without fruit. The supper late in the 
evening, which is considered to promote sleep, consists of- 4 or 5 
ounces of consomme with an ounce of thin toasted bread. For all 
meals the bread, whether whole wheat or white, in the opinion of 
the writer cited, should be thoroughly toasted, a quantity weighing 
3 to 5 ounces before toasting being sufficient for a meal. Butter 
also forms a part of the meals, 3 or 4 ounces being thought desirable 
daily, including that which is used in the cooking. Weak tea or 
coffee with milk and aerated distilled water are recommended as 
beverages. 

It is perhaps hardly fair to estimate the quantities of nutrients 
furnished by this diet, as few of the quantities are definitely stated. 
However, such calculations have been made on the basis of what is 
believed to be an average menu of the character suggested and the 



78 

average amounts of the different foods which would be served ordi- 
narily. 

The quantities assumed per man per day were 2 eggs, 4 ounces; 
toast, 3 ounces; fowl, 3 ounces; vegetable soup, 6 ounces; tenderloin 
steak, 3 ounces ; rice pudding, 6 ounces ; oranges, 5 ounces ; consomme, 
G ounces; vegetables (as potatoes), 5 ounces; bread, 9 ounces; butter, 
3.5 ounces ; sugar, 1.5 ounces ; and milk, 4 ounces. On the basis of 
average values for composition this daily ration would supply 103 
grams protein and 1,820 calories of energy. This is practically the 
amount of protein, but considerably less energy than is called for by 
the standard proposed by Voit for old men. 

Diet in old age is discussed by H. Campbell in a recently published 
volume,® edited by G. A. Sutherland, dealing with diet and dietetics 
in health and disease. The most suitable diet for the aged, it is 
pointed out, is that — 

which constitutes the ideal diet for man in general. Such a dietary demands 
(a) moderation in quantity, (&) simplicity in quality, and (c) the avoidance of 
those starchy foods which are apt to slip into the stomach without having been 
first adequately insalivated * * *. 

By a simple diet is meant one consisting of such items as bread, plain 
biscuits, plain puddings, plainly cooked vegetables, fruit, meat, bird, fish (all 
plainly cooked), milk, butter, cheese (such as Cheddar), tea, coffee, cocoa, salt. 

Doctor Campbell has devoted a great deal of attention to the study 
of the evolution of the diet of man, and in his discussion of diet for 
the aged considers the subject to some extent from, this standpoint. 

It is worthy of note that the diet of early man conformed to these three 
requirements. It was simple, consisting as it did of unprepared animal and 
vegetable substances; the quantity was not on the whole in excess of physio- 
logical needs; and all the starchy food being raw, it had to be abundantly 
masticated in order to break up the nondigestible cellulose framework and thus 
liberate the contained foodstuffs. 

The three important food functions from a dietetic standpoint, as 
the author points out, are " digestion (i. e., the conversion of the 
ingested food into nutrient plasma), metabolism (i. e., the nutritive 
changes which the absorbed food undergoes in the tissues), and 
excretion (i. e., the removal of waste products). 

These three functions, as we may term them, are most vigorous in youth and 
early adult life. Then it is that digestion is most vigorous, metabolism most 
active, and excretion most efficient. At 40, or thereabouts, the digestive func- 
tion often begins to show signs of failure, and greater care has to be exercised 
in the selection of food than was before necessary. Apart from this there is 
now a greater disposition to prudence — the recklessness of youth tends to depart 
with maturer years * * *. This dietetic imprudence may survive child- 
hood, adolescence, early adult life, nay, it may persist into old age, but most 
people have acquired some sort of dietetic wisdom by the time they have 
reached middle age. 

a A System of Diet and Dietetics. London, 1908, pp. 731-740. 



79 

At this period not only does digestion often begin to lose its former vigor, 
but metabolism also shows signs of flagging * * *. 

Except in the case of definite disease of the excretory organs, it is doubtful 
whether the aged suffer in any marked degree from their inefficiency. 

Regarding the dietetic instincts of the aged, some general state- 
ments are made, from which the following are quoted : 

Though doubtless the appetite for plain food tends to lose its keen edge with 
advancing years, and the dietetic instinct — the liking for different kinds of 
food — to alter somewhat, the changes in these respects are often less marked 
than might perhaps have been expected. 

The appetite for plain food may last to extreme old age. We have found 
from inquiry at several workhouses that the aged inmates have, for the most 
part, right good appetites for the simple fare provided, and that their dietetic 
instincts are much the same as those of their younger companions * * *. 

Perhaps the most notable change which the dietetic instinct undergoes with 
advancing years is expressed by the gradual curtailment of starchy and sugary 
food during early and middle adult life. Most children are very fond of sugar 
and cakes, but this liking often suffers a marked diminution when adult life is 
reached. This is more noticeable in the man than in the woman * * *. 
After middle life the saccharids are often still further cut down : The " sweet " 
becomes the least welcome part of the meal and is frequently passed by. 

With respect to the capacity of the organism to cope with different 
kinds of food, the influence of custom and idiosyncrasy, as well as 
old age, must be reckoned with, as Doctor Campbell points out. 

As to the first of these influences, while one should be cautious in recom- 
mending to an aged person a diet very different from that to which he has 
for many years been accustomed, the experience derived from prisons, work- 
houses, and similar institutions shows that the ability of the aged to adapt 
themselves to novel kinds of diet is by no means small. * * * 

The factor of idiosyncrasy is an important one. Individuals differ greatly, 
quite irrespective of age, in their digestive and metabolic capacities. We 
meet with children who are unable to tolerate foods which old people can digest 
quite easily, and, again, with others who are made ill by even a slight excess, 
while their grandparents can perhaps consume a large excess with comparative 
impunity. Some old people have, in fact, prodigious powers of digestion and 
metabolism. * * * Most of these remarkable old people would doubtless 
enjoy better health * * * on a more abstemious diet ; nevertheless, in 
regulating their food we must make due allowance for their prodigious powers 
* * * 

Making due allowance, however, for the personal element, our rule obtains 
that while all should endeavor to conform as far as possible to the ideal dietary, 
allowing themselves no more than an occasional excess, it becomes with ad- 
vancing years increasingly necessary for the majority of people to eat moder- 
ately of simple foods, and not to swallow starchy foods without having first 
insalivated them thoroughly. If we add to these rules the further ones that 
old people should take full advantage of dental surgery, that in the case of the 
toothless certain of the tougher varieties of food should be broken up mechan- 
ically before being taken, and finally that due regard should be had to the 
influence of idiosyncrasy and habit, we have said all that is worth saying 
concerning the diet of the aged. 



80 

The dietary for men from 60 years of age at one of the large 
London workhouses, according to Doctor Campbell, a consists of 20 
ounces bread, 1 ounce oleomargarine, 1 ounce sugar, 4 ounces meat, 
8 ounces potatoes, and 4 ounces green vegetables per day, with pud- 
ding once a week and stewed fruit twice a week. Salt and pepper are 
allowed daily and mustard once a week. Each person is allowed 2 
pints of tea a day. The bread, it is stated, is baked from grain 
ground on the premises. Most of it is made from so-called " whole 
meal," but a small portion consists of 2 parts of white flour and 1 
part of whole meal. 

For purposes of comparison with the other data included in this 
bulletin, the nutritive value of this dietary has been calculated by 
means of average figures, and, as shown by data in the table on 
page 84, supplies 79 grams protein and 2,340 calories per man per day. 

Concerning this diet Doctor Campbell makes the following state- 
ments : 

It must be admitted that this is an ample allowance, probably in excess of 
actual requirements. Nevertheless, most of the inmates, even the very old ones, 
consume the whole of their portion and appear to enjoy it thoroughly. The 
toothless among them seem to manage quite well; the bread crusts they soak 
in their tea, and the meat is generally, though by no means in every case, 
minced for them. 

It is noteworthy that these old people complain very little of indigestion, 
and — what is even more surprising — suffer little from constipation. Thus in 
one large workhouse each inmate gets on an average no more than three doses 
of aperient in the year. Doubtless this comparative absence of indigestion 
and constipation is to be explained by the simplicity and good quality of the 
food provided, by the clock-like regularity of the daily routine, and by the high 
hygienic standard prevailing in the workhouse. 

Of special studies with aged persons the following seem partic- 
ularly interesting: 

In connection with an extended series of studies on respiration and 
metabolism, carried on by Sonden and Tigerstedt & with a respiration 
apparatus of special construction, young, middle-aged, and old sub- 
jects were included. The data recorded show that with both men 
and women the amount of carbon dioxid excreted per square meter 
of surface area is greater with young than with older persons, which 
it is believed is a proof that, independent of its smaller size, the young 
organism possesses a more active metabolism than the older one. In 
youth the carbon dioxid excreted per kilogram of body weight and per 
square meter of surface area is greater with males than with females. 
This difference gradually diminishes, and in old age there is no dif- 
ference in the sexes in this respect. 

a A System of Diet and Dietetics. London, 1908, pp. 731-740. 
6 Skand. Arch. Physiol., 6 (1895), p. 1. 



81 

Kovesi a found, in studies with women aged, respectively, 76 and 
18 years, that it was possible to attain nitrogen equilibrium with 
L0.6 to 12.3 grams of nitrogen per day, and that in extreme old age 
:he energy requirements of the body were lowered, 20 calories per 
lay per kilogram body weight being, in his opinion, the lowest limit, 
rhe conclusion was also reached that cell metabolism is less active in 
)ld age than in youth and that this accounts for the diminished pro- 
:eid requirement which was observed and which is considered char- 
icteristic of old age. 

From his experiments with old women, von Limbeck 5 concluded 
:hat the digestibility of protein and fat was normal and that, in 
general, the proportion of the different nitrogenous constituents of 
:he urine was practically normal with the exception of ammonia. 
Notwithstanding the low energy value of the diet, both his subjects 
gained in weight and excreted less nitrogen than was consumed. In 
Dther words, the nutrients and energy supplied by the food seemed 
imply sufficient for the body needs. 

A woman whose dietary was studied by Fenger c was 61 years old 
it the beginning of the experimental period and was under observa- 
tion at intervals for fifteen years. From choice her diet was very 
dmple, consisting of such foods as eggs, oatmeal, soup, skim milk, 
fruit, and a little wine. On this simple diet the subject remained in 
rood health and seemed normal as regards the assimilation of nitro- 
gen. No tests were made of the effects of diets of different character. 
Fenger considers it fair to conclude that a diet may be considered 
suitable for the old which contains protein enough to supply body de- 
nands and maintain health through long periods, requirements which 
tvere evidently met by the diet selected by the subject of his experi- 
nents. 

Interesting and valuable as these and other similar investigations 
undoubtedly are, it is evident that they do not furnish so broad a 
oasis for dietary standards as do the much more numerous studies of 
persons in full vigor. The standards most commonly accepted for 
the aged are those of Voit, who bases them mainly on the work of 
Forster. They indicate a ration with about 0.8 of the nutritive value 
:>f those indicated for men or women in full vigor and at moderate 
muscular work ; in other words, from 90 to 100 grams of protein and 
from about 2,100 to about 2,900 calories of energy per man per day, 
or from 80 to 100 grams of protein and from 2,100 to 2,900 calories 
of energy per woman per day, the amounts .to be varied according 
bo the muscular work performed. 

°Centbl. Inn. Med., 22 (1901), p. 121. 
6 Ztschr. Klin. Med., 26 (1894), p. 437. 
c Skand. Arch. Physiol., 16 (1904), p. 222. 

16553— Bull. 223—10 6 



82 

One of the most thorough attempts to determine exactly the amount 
of nutrients necessary for the maintenance of the body at different 
ages is that of Maurel.° He estimates from his own clinical and 
experimental observations and those of others that to maintain the 
body in equilibrium when no external muscular work is performed 
the adult in full vigor, either man or woman, requires 1.5 grams of 
protein and from 35 to 38 calories of energy per kilogram of body 
weight, any muscular exertion being met by an increased supply 
of nutrients. Thus, for a man weighing 70 kilograms (151 pounds), 
the daily maintenance ration, according to Maurel, should con- 
tain 105 grams of protein and from 2,450 to 2,660 calories of energy, 
or for a woman weighing 60 kilograms (132 pounds), 90 grams 
of protein and from 2,100 to 2,280 calories of energy. For persons 
in the first period of physical decline (from 50 to 70 years), he 
considers that the protein may be reduced to 1.25 grams and the 
energy to from 30 to 35 calories per kilogram of body weight. In the 
second period of old age (from 70 years on), he believes that the 
nutritive demands fall off yet more until, in extreme age, 0.75 grams 
of protein and from 20 to 25' calories of energy per kilogram of body 
weight are ample to maintain the body in equilibrium. Of course, 
as age increases, general muscular exertion usually decreases also, so 
that the maintenance ration just quoted approaches the total require- 
ment much more nearly than do those given for persons in full vigor, 
even where the latter perform little external muscular work. It 
should also be noted that body weight usually decreases rapidly in 
old age, even among people whose food is abundant, and hence, if we 
estimate nutritive requirements per kilogram of body weight, they 
decrease correspondingly. 

If we take the average weight of persons in old age as given by 
Quetelet 6 and apply to them the maximum factors suggested by 
Maurel we find the maintenance ration to be as given in the following 
table : 

Estimated food requirements of aged men and women based on Maurel and 

Quetelet figures. 



Subjects. 


Age. 


Average weight. 


Protein 
required. 


Energy- 
required. 




Years. 
60 
70 
80 
90 
60 
70 
80 
90 


Kilograms. 
65.50 
63.03 
61.22 
57.83 
56.73 
53.72 
51.52 
49.34 


• Pounds. 
144.1 
138.7 
134.7 
117.2 
124.8 
118.2 
113.3 
108.5 


Grams. 
81.9 
78.8 
45.9 
43.4 
70.9 
67.2 
38.6 
37.0 


Calorics. 
1,965 


Do 


1,891 


Do... 


1,531 


Do... 


1,446 


Women 

Do 


1,702 
1,612 


Do 

Do 


1,288 
1,234 



a Rev. Soc. Sci. Hyg. Aliment., 3 (1906), p. 763. 

b Landois and Sterling: Text-book of Human Physiology, London, 1891. 



83 

While Maurel's factors give for adults in full vigor a ration hardly 
below that commonly accepted, his standards for the aged are lower 
than those usually applied. Since, however, he takes into account the 
decrease of body weight as well as of activity, it may be that they 
represent more nearly the minimum ration which may safely be 
applied. However, they represent a maintenance ration merely, and 
any external muscular work must be met by an increased ration. 

FOOD IN BALTIMORE AND PHILADELPHIA HOMES FOR THE AGED 
COMPARED WITH OTHER INSTITUTIONS AND STANDARDS. 

A summary of the results of the dietary studies in Baltimore and 
Philadelphia is given in the following table, which also includes for 
purposes of comparison the results of a number of dietary studies 
made elsewhere in public institutions, as well as data from the in- 
vestigations and the standards referred to in the preceding section. 

Summary of studies in public institutions and studies with, and standards for, 

aged persons. 





Location and subjects of 
studies. 


Num- 
ber of 
persons 

in 
study. 


Nutrients and energy. 


Study 
No. 


In food eaten. 


In food wasted. 


Proportion in food 
wasted. 




Pro- 
tein. 


Energy. 


Pro- 
tein. 


Energy. 


Protein. 


Energy. 


682 
683 
685 


STUDIES IN INSTITUTIONS. 

Bayview, Baltimore: 

Regular inmates, males . . 
Chronic inmates, males... 
Receiving-ward inmates, 


136 

82 

82 


Grams. 
144 
93 

111 
121 

85 

106 
117 
96 

85 

83 

74 

58 

88 

84 
98 
90 
108 

97 
104 


Calories. 
2,901 
2,076 

2,274 
2,504 

1,924 

2,405 
2,453 
2,398 

2,206 

2,339 

2,225 
1,882 

2,767 

2,599 
2,536 
2,402 
2,694 

2,519 
2,917 


Grams. 

4 
2 

1 
3 

6 

8 
4 


Calories. 
97 
45 

11 
59 

134 

168 
89 


Per cent. 
3 
2 

1 

2 

7 

7 
3 


Per cent. 
3 
2 




Average of 3 studies 


2 


684 


Women inmates, per wo- 


111 

111 
411 


7 


684 


Women inmates, per man 


7 




Average of 4 studies 


3 


686 


Aged women's home, Balti- 
more, per woman per day . . 




12 
9 

8 


308 
304 
265 


14 
11 
11 
8 

13 

21 
11 
12 
11 

26 
10 


14 


687 


Aged men's home, Balti- 




13 


688 


German Aged People's Home, 

Baltimore, per man per day. 

Old Ladies' Home, Philadel- 




12 


691 




8 




Government Hospital for the 

Insane, male patients: & 

Middle to old age, largely 

chronic, orderly, quiet, 

few workers, average of 


952 

94 
169 
89 
80 

166 


13 

22 
12 
12 
13 

34 

12 


341 

567 
315 
306 
319 

802 
256 


11 




Acute, nervous, dis- 
turbed, nonworkers, 
average of 3 studies 

Negroes, whole group 

Negroes, nonworkers 

Negroes, workers 

Sick, infirm, and bedrid- 
den, average of 2 studies . 

Younger and more active 
class, some curable, 
part workers, average 
of 2 studies.. 


18 
11 
11 
11 

24 
8 



a Calculated from food purchased (see p. 36). 
& U. S. Dept. Agr., Office Expt. Stas. Bui. 150. 



84 

Summary of studies in public institutions and studies with, and standards for, 
aged persons — Continued. 



Study 
No. 



Location and subjects of 
studies. 



Num- 
ber of 

persons 
in 

study. 



Nutrients and energy. 



In food eaten. 



teta. Ener ^- 



In food wasted. 



fern". Ener ^ 



Proportion in food 
wasted. 



Protein. Energy 



STUDIES IN INSTITUTIONS— COn 

Government Hospital for the 
Insane, male patients — Con . 
Better class, on first sec- 
tion diet, average of 2 

studies 

Unclassified, average of 

2 studies 

Unclassified, average of 

all patients 

New York state hospitals for 
the insane, male patients: 
Chronic, infirm, average 

of 8 studies 

Light workers and dis- 
turbed, average of 2 

studies 

Restless, active, d i s - 
turbed, average of 2 

studies 

Workers, average of 10 

studies 

Acute, recent admission, 

average of 2 studies 

Acute and sick, chronic, 

average of 2 studies 

Almshouse, Baltimore, 1852: a 

Nonworkers 

Workers 

Long Island almshouse and 

hospital, Boston & 

Charlestown almshouse and 

hospital, Boston & 

Scotch poorhouse: c 

Adults, both sexes, just 

admitted, no work 

Adults, both sexes, regu- 
lar inmates, no work. . . 
Adults both sexes, regu- 
lar inmates, work 

Scotch Almshouse for Pauper 
Lunatics: d 
Excessive dietaries, 
males, average of 11 

studies 

Dietaries approximating 
standards, females, av- 
erage f f 13 studies 

Deficient dietaries, 
males, average of 15 

studies 

Excessive dietaries, 
females, average of 25 

studies 

Dietaries approximating 
standards, females, av- 
erage of 8 studies 

Deficient dietaries, 
females, average of 6 

studies 

Home for Old Men, Munich e. 
Home for Old Women, Mu- 
nich e 

Old men (over 60 years) 
workhouse, London / 



22 
127 



Grams. 
125 



318 

258 

1,595 

70 

35 



95 
105 
65 



109 

71 



112 

149 
136 

119 
119 
108 



: 



Calories. 
3,398 

2,609 

2,704 

2,259 

2,255 

2,665 

2,908 

2,477 

2,432 

1,959 
2,057 

3,164 

2,415 

1,870 
2,030 
2,380 

3,789 
3,340 
2,998 
3,057 
2,695 



2,488 
2,155 



1,875 
2,340 



Grams. 
29 



Calories. 
753 



539 
415 



142 
132 
161 
94 



Per cent. Per cent. 
18 



a Calculated from data given by Gould; Report on Food and Diet Suited for Almshouses, Prisons, and 
Hospitals. New York, 1852, p. 79. 

b Ellen H. Richards and Sarah E. Wentworth; Second Report of Institutions Commissioner. Boston, 
1897, p. 206. 

c R. E. Aitchison. Some Effects of Certain Diets Upon Excretion by the Kidneys and by the Blood. 
Edinburgh, 1896. Cited by Dunlop; Report Prison Dietaries. Glasgow, 1899, p. 127. 

d J. C. Dunlop. Supplement to Report Board of Commissioners in Lunacy. Scotland, 43 (1902), p. 92. 

e Forster. Cited from U. S. Dept. Agr., Office Expt. Stas. Bui. 21. 

/ G, A. Sutherland. A System of Diet and Dietetics. London, 1908, p. 731. 



85 

Summary of studies in public institutions and studies with, and standards for, 
aged persons — Continued. 



Study 
No. 



Location and subjects of 
studies. 



STUDIES "WITH INDIVIDUALS. 

Woman, 79 years old, weight 

38 kilograms, 1st study «.... 
Woman, 79 years old, weight 

38 kilograms, 2d study a. . . . 
Woman, 81 years old, weight 

37 kilograms a 

Woman, 76 years old, weight 

45 kilograms, 1st study ft. . . . 
Woman, 76 years old, weight 

45 kilograms, 2d study ft — 
Woman, 76 years old, weight 

45 kilograms, 3d study ft. . . . 
Woman, 78 years old, weight 

61 kilograms, 1st study ft.... 
Woman, 78 years old, weight 

61 kilograms, 2d study ft 

Woman, 78 years old, weight 

61 kilograms, 3d study ft — 
Woman, 61 years old, 1st 

dietc 

Woman, 61 years old, 2d 

diet c 

Woman, 61 years old, 3d 

diet c 

Woman, 61 years old, 4th 

diet c , 



DIETAEY STANDARDS. 

Voit's standards: d 

Old man, no work 

Old man, light work 

Old woman, no work 

Old woman, light work. . 
Old people, hard work. . . 
Maurel's maintenance stand- 
ards: e 
Men, 60 years, average 
weight, 66 kilograms. . . 
Men, 70 years, average 
weight, 63 kilograms . . . 
Men, 80 years, average 
weight, 61 kilograms. . . 
Men, 90 years, average 
weight, 58 kilograms. . . 
Women, 60 years, average 
weight, 57 kilograms. . . 
Women, 70 years, average 
weight, 54 kilograms . . . 
Women, 80 years, average 
weight, 52 kilograms. . . 
Women, 90 vears, average 
weight, 49 kilograms. . . 
U.S. Department of Agricul- 
ture standards:/ 
Man, moderate muscular 
work, period of full 
vigor- 
Food purchased 

Food eaten 

Old man or woman- 
Food purchased 

Food eaten 

Extreme old age, man or 
woman- 
Food purchased 

Food eaten 



Num- 
ber of 
persons 

in 
study. 



Nutrients and energy. 



In food eaten. 



Pro- 
tein. 



115 
100 



104 
90 



81-90 
70-80 



Energy. 



Grams. 
71 


Calories. 
1,289 


71 


1,291 


71 


1,226 


77 


1,361 


66 


1,361 


66 


1,165 


41 


1,275 


41 


1,575 


67 


1,207 


80 


1,125 


85 


1,200 


87 


1,230 


84 


1,600 


90 
100 
80 
85 
100 


2,116 

2,689 
1,831 
2,096 
2,898 


82 


1,965 


79 


1,891 


46 


1,531 


43 


1,446 


71 


1,702 


67 


1,612 


39 


1,288 


37 


1,234 



3,800 
3,500 



3,400 
3,150 



2,660-3,040 
2, 450-2, 800 



In food wasted. 



Sn. energy 



Grams. 



Calories. 



Proportion in food 
wasted. 



Protein. Energy 



Per cent. 



Per cent. 



a von Limbeck. Ztschr. Klin. Med., 26 (1894), p. 437. 

ft Kovesi. Centbl. Inn. Med., 22 (1901), No. 5, p. 121. 

«Fenger. Skand. Arch. Physiol., 16 (1904), p. 222. 

d Ztschr. Biol., 12 (1876), p. 32. 

«Seepage82. 

/U. S. Dept. Agr., Yearbook 1907, p. 361. 



86 

In the studies made in the three Baltimore homes for the aged, 
none of the diets provided more than the 85 grams of protein called 
for by the suggested standard for persons in the decline of life, and in 
one case the diet provided only 74 grams. Considering that the sub- 
jects all seemed satisfied with the amount of their food and that their 
general health was as good as could be expected at their age, the 
natural inference is that the suggested protein standard is ample for 
the nutritive needs of persons in extreme age and with comparatively 
little activity — that, indeed, it may be possible to support life com- 
fortably and well on a somewhat smaller amount, as Maurel's work 
has suggested. It does not necessarily follow, however, that the usual 
standard ought, therefore, to be reduced, for the latter is not intended 
to represent the minimum or even the average physiological require- 
ment, but rather to suggest an amount ordinarily demanded by prop- 
erly nourished subjects, and to serve as a basis in planning dietaries, 
especially in public institutions. Since in most public institutions 
economy is rigidly insisted on, there would be more danger to the 
comfort of the inmates from setting the standard too low than too 
high. From this point of view these studies seem to corroborate the 
propriety of the present protein standard. As regards the energy, 
two of the studies showed a consumption within 25 calories of the 
2,200 calories suggested by the standard, while in the other it amount- 
ed to 2,339 calories per man per day. Certainly this does not indi- 
cate too high an energy value in the suggested standard. 

Another interesting point suggested by these studies is the compara- 
tive requirements of men and women in extreme age. It will be re- 
called that the first study in the Baltimore private institutions was 
made in a home for aged women, the second in a similar institution 
for aged men, and the third in a home for the aged of both sexes. 
The protein consumption was highest in the first and lowest in the 
last. The energy consumed per man per day in the men's home was 
about 100 calories more than in either the women's home or that for 
both sexes; but it should be borne in mind that these men averaged 
a little younger and were perhaps also a little more active than the 
subjects in the other studies. These facts hardly sustain the ordinary 
assumption that the food requirements of women are only 0.8 of those 
of men of similar age and activity, but imply rather that, as has been 
pointed out by earlier observers (see p. 80), in extreme age the food 
needs of the two sexes become more or less identical. 

Compared with the results of dietary studies of individuals re- 
ported by von Limbeck, Kovesi, and Fenger, and the estimated nutri- 
tive value of the diet proposed by Sir Henry Thompson, the groups 
studied in Baltimore and Philadelphia obtained in their diet an 
abundance of both protein and energy. 



87 

The studies here reported have already been discussed to some 
extent in comparison with other institutions (see pp. 43, 44). 

The smallest amounts of protein and energy noted in the present 
studies among the aged were found in the home for aged women in 
Philadelphia. When we consider, however, that the average age of 
the inmates was about 78 years, and that their muscular activity 
was probably very slight, it seems not improbable that the 58 grams 
of protein and 1,882 calories of energy supplied by the diet were 
amply sufficient for their needs. According to Maurel, 39 grams of 
protein and 1,288 calories of energy is a maintenance ration for 
women of 80; the 19 grams of protein and 594 calories of energy in 
excess of this should be sufficient for the small amount of muscular 
exercise taken. Considering that in this study the food, served was 
not limited in amount and at the same time appeared appetizing, so 
that the inmates were not prevented by lack of food or by distaste 
from eating all they needed, it may be taken to indicate that amounts 
lower than those suggested by Yoit may be ample for persons in 
extreme age. 

No special standards for the aged have been proposed hitherto as 
a result of data obtained in the Department of Agriculture nutrition 
work, as little material gained by experimental studies was available 
on which to base them. Voit's factors have usually been accepted as 
indicating an abundant ration for institution dietaries for the aged. 

On the basis of the work reported in this bulletin and other avail- 
able data, it seems fair to propose 0.9 as the factor representing the 
proportion of protein and energy required in old age by a man or 
woman as compared with a man at moderate muscular work during 
the period of full vigor, and 0.7 to 0.8 as the factor representing the 
relative food requirement for extreme old age. The actual quanti- 
ties of protein and energy will vary according to the basis of compari- 
son selected, whether it be food purchased, food eaten, or food. 
digested. a The standard proposed is generous rather than the reverse 
and is in accord with American food habits, and seems a reasonable 
guide for use in institutions or homes in planning diet for the aged. 

DIETARY STUDIES WITH CHILDREN AND THEIR RESULTS. 

A large number of carefully conducted investigations on infant 
feeding have been reported, and the literature on the subject is exten- 
sive, but relatively few studies have been made in connection with 
the nutrition problems of older children. 

Of recent work with infants, the investigations of Michel and 
Perret & on the rational feeding of infants from birth to 2 years 

a TJ. S. Dept. Agr., Yearbook 1907, p. 61. 

& Rev. Hyg. et Med. Infant, 5 (1906), No. 6, p. 477. 



may be mentioned as representing methods followed in the accumu- 
lation of data and the application of the results of highly technical 
experiments to the practical problems under consideration. When 
possible, everyone concedes that it is best that the infant should be 
breast fed, but when this is impossible substitutes for natural feed- 
ing must be found, and these authors have endeavored to establish a 
scientific ration for the artificial feeding of infants. They have 
taken as a basis for their calculation a large amount of experimental 
and empirical data which they summarize with respect to the average 
weight of new-born infants, the gain in weight during different 
periods, the nature of the gain in terms of the composition of the 
body, the amount and character of material ingested and egested by 
infants breast fed and nourished on cow's milk diluted with water 
and sweetened with milk sugar, the amount of energy eliminated 
by infants per kilogram of body weight and per square meter of 
surface area, and similar data. 

According to the calculations which they give, an infant weighing 
8 kilograms has a surface area of 3.696 square meters, and on the basis 
of 150 calories per square meter would require 554 calories of avail- 
able energy for maintenance. The calculated amount of nitrogen 
necessary for a gain of 1 gram in body weight is 0.02179 gram. 
Taking account of these values, they propose a ration which can be 
modified to provide for the proper maintenance and growth, in accord- 
ance with the different weights of the infant at different periods, 
and report observations on the effects of feeding a number of infants 
in accordance with the method proposed. 

Mention should also be made in this connection of important papers 
recently published by Rubner on nutrition processes during the 
growth of the child,® the theory of nutrition after completion of 
growth, 6 and problems of growth and length of life from the stand- 
point of energetics. 

In his theoretical discussion of diet during the period of growth 
Rubner emphasizes the importance of energy constituents, and gives 
reasons for his belief that the protein requirement of children has 
been sometimes overestimated. 

In the second of the papers referred to theories of nutrition are dis- 
cussed chiefly with reference to protein metabolism. This factor, the 
author states, varies according to the protein requirements of the cell, 
the cell with little protein retaining more of the protein supplied to it 
than one which is rich in this constituent. For this reason a large 

°Arch. Hyg., 66 (1908), No. 1-2, p. 81. 

6 Arch. Hyg., 66 (1908), No. 1-2, p. 1. 

c Arch. Hyg., 66 (1908), No. 1-2, p. 127; Sitzber. K. Preuss. Akad. Wiss., 1908, 
II, p. 32; Das Problem der Lebensdauer und seine Beziehimgen zu Wachstuni 
und Erniihrung. Munich, 1908. 



89 

protein supply does not cause so great nitrogen excretion in the 
former case as in the latter. 

The author discusses nitrogen metabolism and gain on a basis of 
the amount of nitrogen present in the body rather than on the usual 
basis of body weight. Cell function is the primary consideration 
in protein metabolism. The cleavage of protein accommodates itself 
to this factor, and there is a relationship between cell function and 
the size of the body. Within certain limits nitrogen metabolism is 
more rapid the more protein is supplied. 

The problems pertaining to growth and length of life, Rubner dis- 
cusses with reference to man and other mammals, particularly from 
the standpoint of energetics. With respect both to the amount of 
protein and energy required during the nursing period to double the 
body weight, man, he states, forms an exception to the other mammals 
included in the discussion, in that on a uniform basis of comparison he 
requires smaller quantities of protein and about six times as much 
energy, the domestic mammals requiring on an average, according to 
the author's calculations, 4,808 calories for building a kilogram of 
body material. 

A comparison is also made between man and other mammals with 
respect to the proportion of energy supplied during the nursing period 
which is retained in the body. In this respect man also differs from 
the ordinary domestic animals, since he retains only 5.2 per cent of the 
net energy supplied, in comparison with 34.3 in the case of domestic 
animals. This value is called by the author " quotient of growth." 
He estimates further that in domestic animals the ratio of food supply 
to maintenance is 202 to 100, and in man 120 to 100, so that in the case 
of domestic animals 69 per cent of the material supplied is retained, 
in comparison with 6.2 per cent in the case of man. 

According to Rubner's summary, the time required by the young 
animal for doubling the body weight is inversely proportional to the 
intensity of metabolism, and therefore the shorter the period of 
growth the greater the metabolism of energy. The intensity of energy 
metabolism is a function of surface area, and therefore small animals 
show the more rapid growth. 

In his discussion of the duration of life Rubner estimates that in 
the domestic animals each kilogram of body weight after growth is 
completed requires practically the same quantity of energy. Man 
forms an exception to this rule, in that he requires about four times as 
much as the other mammals. It follows, therefore, that man requires 
a greater proportional energy supply than other mammals. 

The nutrition publications of this Office and other similar publica- 
tions commonly give factors showing the dietary requirements of chil- 
dren in comparison with adult man at moderate work. These deduc- 



90 

tions very largely depend upon experimental evidence reported by 
Voit and others, which has been summarized in previous publications 
of this Office,® including the classic work of Camerer with his own 
children at different ages, and studies with other children by Forster, 
Uffelmann, Hasse, Schroeder, and Prausnitz, together with later work 
by Magnus-Levy, Pautz, and others. 

Camerer's 6 work is especially noteworthy, both for its extent and 
the thoroughness with which it was conducted. Details of foods con- 
sumed, gains in weight and height, and similar data are recorded, as 
well as the results of extensive digestion experiments and studies of 
the income and outgo of nitrogen. The results obtained in Camerer's 
earlier work have been summarized in the Department of Agriculture 
publications referred to above, and are included in averages given in 
the table on page 94. 

In a publication which appeared more recently he considers the 
whole question from the standpoint of metabolism from birth to the 
end of the period of growth. His later work with children has to do 
more particularly with infants and their digestion, metabolism, and 
growths 

Maurel's extensive work and deductions regarding the food of 
children are referred to elsewhere (see p. 95) in a discussion of the 
dietary studies reported in tl>is bulletin. 

A few studies with infants and children have been reported in con- 
nection with the nutrition investigations of this Office, though the 
amount of this work is limited, owing to general conditions under 
which the enterprise has been conducted. Atwater and Woods 6 
report dietary work with an infant, while Jaffa, of the California 
Experiment Station, reports similar work and studies of children 
living on a fruitarian diet. f 

As regards general discussions of the feeding of children, particu- 
larly during periods of infancy, the literature is perhaps more exten- 
sive than is the case with almost any other question of dietetics. 

° U. S. Dept. Agr., Office Expt. Stas. Bnls. 21 and 45. 

6 Ztschr. Biol. (1880), p. 24; (1882), p. 220; (1884), p. 556; (1888), p. 141; 
(1893), pp. 227, 398. 

c Der Stoffwechsel des Kindes von der Geburt bis zur Beendigung des Wachs- 
tums. Tubingen, 1896. 

d Die Verdauungsarbeit, ihre Grosse und ihr Einfluss auf den Stoffwechsel, 
insbes. den Stoffwecbsel des Sauglings. 1900. Reprinted from Jahrb. Kinder- 
heilk., n. ser., 51 (1900), p. 26. 

Zur Physiologie des Sauglingsalters. Berlin, 1902. Reprinted from Jahrb. 
Kinderheilk., n. ser., 56 (1902), p. 543. 

Die korperliche Entwicklung, die Ernahrung und Pflege des Kindes. Stutt- 
gart, 1902. 

c Connecticut Storrs Sta. Rpt. 1895, p. 129. 

1 U. S. Dept. Agr., Office Expt. Stas. Buls. 107, 132, 



91 

Of recent discussions of the diet of children may be mentioned the 
monograph by Miss Caroline L. Hunt on the food of school children. 
which sums up the bulk of the published literature on this subject. 

As to the character of the different meals, Miss Hunt states that, 
while a general idea of the amount of food required should be kept 
in mind, no special effort need be made to balance each meal. 

In general, the simplest foods should be given at night. Bread, milk, and 
simple -sweets, like stewed fruits or plain cake, make a good supper for little 
children. The most important parts of the breakfast are milk, cereal- or toast, 
and 'fruit. The question arises with school children whether the heavy meal 
ought to be at noon or night. At noon the meal may interfere with the after- 
noon work, at night with sleep. It should be remembered that the heavy 
meal usually means the one which includes meat. The nourishment obtained 
by the grown person from meat is secured by the child from milk. This may 
be so distributed through the different meals that there need be no especially 
large meal. The lunch taken by older people, with the addition of milk, can 
be considered the dinner of the child. His supper can then precede the regular 
dinner of the family, and be very simple though nutritious. For school children 
a warm liquid is desirable at noon. This may be soup or cocoa. Chocolate is 
too rich. The fact that fats remain longer in the stomach than other sub- 
stances makes it particularly undesirable to serve fatty foods at noon if the 
child is to return soon to work. 

Many of the medical text-books and works of reference on diet 
under conditions of health and disease take up the question of the 
feeding of children of different ages. In an article of this character 
which forms a part of recent work on dietetics and which embodies 
the results of clinical experience as well as other information, G. A. 
Sutherland h summarizes and discusses a large amount of information 
on the feeding of infants before and after weaning and of children 
from the second to the seventh year and during school life. 

As regards diet from the second to the seventh year, the period 
characterized by active exercise, it calls for " an increased amount of 
carbohydrates and of proteins; in other words, of energy-producing 
and muscle-forming materials," as compared with the previous diet, 
and, according to the author, should be made up of simple foods, such 
as milk, eggs, butter, cream, minced or finely cut meat, fish, vegetable 
soups, light meat soups, cereals, simple puddings, vegetables, and 
fruits. 

Bread forms a most important element in the diet. The amount of bread 
and butter or jam that an active 4-year-old child will consume at a meal is 
astonishing. Care must be taken, however, that the butter or jam is not the 
element which makes the bread go down. White or brown bread may be used, 
and it should be at least twenty-four hours old. It may be plain or toasted. 
All plain biscuits are also to be allowed, sweetened ones being regarded as an 
occasional luxury * * *. 

° Bur. of Ed. [U. S.] Bui. 3, 1909, p. 7. 

6 A System of Diet and Dietetics. London, 1908, pp. 743-799. 



92 

The natural demand of the organism for sugar must be fully satisfied, and it 
is better to do so by the use of sugar in the food than by the artificial prod- 
ucts of the manufacturer, which are often taken in excess apart from meals. 
Puddings and stewed fruit can be suitably sweetened. Honey, sirup, and jam 
can be taken with bread, biscuits, and puddings. At the same time it is not 
advisable to ruin the taste for plain foods by oversweetening a number of the 
dishes. 

Fruits contain a considerable amount of sugar in a very assimilable form 
* * *. In hot weather it will be found useful to reduce the amount of the 
more substantial elements of the diet and to increase the amount of the fruit 
and vegetables. Special care must be taken to insure that the fruit is in proper 
condition, i. e., neither unripe nor too ripe, as unwholesome fruit disturbs the 
alimentary tract most seriously * * *. 

The training in mastication should be perseveringly continued by the use 
of some hard articles of food. Until this is learned it may be necessary to 
give meat in a pounded, minced, or shredded form. The habit of bolting the 
food, acquired from the fluid diet of infancy, must be checked, and a slow 
methodical habit of eating should be acquired early in life. 

In considering diet during school life, Sutherland considers the 
problem both with reference to home conditions and the boarding- 
school system which, particularly for boys, is such a characteristic 
feature of English school life. At about the eighth year, when the 
author assumes that school life begins, the child has reached an age 
when — 

In addition to the requirements of the body for growth, repair, and exer-. 
cise, we have to consider the work of the brain in connection with the diet. 
It is recognized by all that a growing boy or girl requires a large amount of 
nourishing food, and that at the same time the amount varies very largely with 
the individual. Consequently it is not advisable to stuff the child who does not 
appear to come up to an imaginary standard, or to starve the child who seems 
to go beyond it. If the child is having a duly apportioned amount of work 
and play, of sleep and out-of-door exercise, his appetite will be the best guide 
as to the amount of food required. The appetite must be a healthy one, i. e., 
trained on a diet of wholesome, plain foods, for a pampered appetite, pre- 
viously developed on dainty highly seasoned dishes, can not be regarded as of 
any value whatever as a test. 

If the appetite is debased in any way Doctor Sutherland empha- 
sizes the importance of special study and special treatment. 

As with adults, a very important factor in determining the amount 
of food is the physical work performed. The amount of exercise 
which a child takes in the open air will have a direct influence on the 
appetite and also on the quantity of food he should take. Exercise 
before food should not be pushed to the extent of producing ex- 
haustion, or both the appetite and the digestion will be impaired. 
The natural man tends to rest after a meal, but the healthy child 
will be eager for exercise. Consequently it is not necessary to forbid 
such exercise, provided that it is of the nature of play, and not of a 
tiring character. 



93 

The quality of the diet should be such that a due proportion of proteins, 
carbohydrates, and fats enter into it. The chief difference from the feeding 
in earlier years is that a larger amount of beef and mutton is called for. 
Although the proteins required can be supplied in other foods, meat has the 
advantages of being the most concentrated, the most digestible, and the most 
palatable form in which they can be given. Meat should be given twice a day 
* * *. Additional proteins are to be supplied in the form of milk, eggs, oat- 
meal, etc. 

The quality of the food is a matter of great importance, to which 
the author devotes particular attention. 

If from any reason * * * a distaste for meat or vegetables is produced, 
the result will be that the feeling of 'hunger will lead the boy to satisfy it by 
eating undesirable things, such as sweets, pastry, etc., in excess. These latter 
appeal to the boyish appetite at all times, and are not in themselves injurious 
when given in moderation at meals. It is when wholesome and appetizing food 
is not supplied at table that the habit of eating unwholesome things between 
meals is developed. 

The quality of the food depends greatly on the cooking. As plain cooking is 
all that a healthy boy's appetite demands, it is not asking too much to say that 
the food ought always to be well cooked * * *. 

Tea and coffee may be added to the dietaries hitherto given, but should not 
be taken in excess or too strong. Milk at this age will be taken much more 
readily if flavored with tea or coffee * * *. 

The chief meals of the day should be three in number — breakfast, dinner, and 
supper. Of these the first two should be the substantial meals, while supper 
should consist of less stimulating material * * *. There should be no hur- 
rying over meals, no bolting of the food * * *. With three good meals in 
the day no boy should suffer from hunger or from failure of nutrition from lack 
of food. While greediness as regards food must be checked in certain cases, as 
it breeds physical ills if tolerated, one must not allow a healthy appetite to re- 
main unsatisfied on the ground that moderation is a desirable virtue. 

It would be possible to greatly extend the citations of deductions 
and opinions of investigators and writers on the subject of the feed- 
ing of children, but perhaps enough has been quoted to indicate the 
extent of the work, the character of the evidence on which conclusions 
are based, and the deductions of some of those who have approached 
the subject from the standpoint of the physician, the investigator, and 
the educator. 

The results of the investigations in Baltimore and Philadelphia 
are summarized in the table which follows, together with the results 
of some data from other sources. 



94 



Dietary studies with and standards for children. 



Description of study or standard. 



Num- 
ber of 
persons 



Average 



Average weight. 



Protein 
per day. 



Energy 
per day. 



STUDIES IN BALTIMORE AND PHILADELPHIA. 

Home for Colored Children , Baltimore , boys . 
German Orphan Asylum, Baltimore, boys. 
German Orphan Asylum, Baltimore, girls. 

Orphan Asylum, Philadelphia, boys 

Orphan Asylum, Philadelphia, girls 

Average of above studies 



FOREIGN STUDIES. 



Children, 2-6 years & 

Children, 6-10 years & , 

Children, 10-14 years & 

Children, 6-15 years, Orphan Asylum, 

Munich c 

Boys, 8-15 years, Children's Home, 

Rostock d 

Girls, 14-19 years, Industrial School, 

Essen e 

Boy / 

Boy, average of 2 studies 9 



Years. 

9 
12 
12 

9 
11 
10 



Pounds. 
58.6 
59.2 
74.3 

a 62 

a 69 
67 



38 



SUGGESTED MAINTENANCE REQUIRE- 
MENTS, ft 



Child 

Do 

Do 

Do 

Do 

Do 

Do 

Do 

Youth 

Do 

Do 

Early maturity. 

Do 



u. 



DEPARTMENT OF AGRICULTURE 
STANDARDS, i 



Child, 2-5 years (0.4 food of man).. 
Child, 6-9 years (0.5 food of man).. 
Boy, 10-11 years (0.6 food of man). 

Boy, 12 years (0.7 food of man) 

Boy, 13-14 years (0.8 food of man). 
Boy, 15-16 years (0.9 food of man). 
Girl, 10-12 years (0.6 food of man) . 
Girl, 13-14 years (0.7 food of man). 
Girl, 15-16 years (0.8 food of man). 



22 

26.5 

33.1 

39.7 

44.1 

55.1 

66.1 

88.2 

110.2 

121.3 

132.3 

143.3 

143.3 



;35 
a 55 
a 67 
a 78 
a 85 

nn 



nn 



Kilograms. 
26.6 
26.9 
33.7 
28.1 
31.3 
30.4 



15.9 
24.9 
30.4 
35.4 
38.6 
53.7 
31.3 
40.4 
50.4 



Grams. 
50 

65 

68 
61 



IS 
22 
26 
32 
35 
42 
53 
70 
85 
94 
103 
103 
90 



Calories. 
1,677 



1,876 
1,784 



1,245 
1,575 
1,780 



2,905 

2,815 
1,960 
3,250 



675 
792 
937 
1,053 
1,130 
1,350 
1,545 
1,720 
2,213 
2,406. 
2,565 
2,567 
2,405 



1,400 
1,750 
2,100 
2,450 
2.800 
3,150 
2,100 
2,450 
2,800 



a Metropolitan Life Insurance Company tables. 

b Forster, Camerer, UfEelman, and Hasse. From Summary in U. S. Dept. Agr., Office Expt. Stas. Bui. 
21. See also U. S. Dept. Agr., Office Expt. Stas. Bui. 45. 
<"Voit. Untersuchung der Kost, p. 125. 
2 Schroder. Arch. Hvg., 4 (1866), p. 39. 
ePrausnitz. Arch. Hyg., 15 (1892), p. 387. 
/ Pautz. Ztschr. Biol., 37 (1895), p. 206. 
a Magnus-Levy. Arch. Physiol. [Pfiuger], 53 (1893), p. 547. 
h Bowditch. Loc. cit. 
t"U. S. Dept. Agr., Yearbook 1907, p. 361. 
/Maurel. Loc. cit. 

It is commonly assumed that growing children need more nutrients 
in proportion to their size than adults, first, because extra material 
is needed for bodily groAvth ; and second, because they have a propor- 
tionately larger body surface and require more energy to make good 
the greater evaporation through the skin. Since girls 6 years old 
or more usually weigh less than. boys of corresponding age, it is also 
assumed that their nutritive requirements are slightly less. From 
these assumptions and the practical observations available, the nutri- 



95 

tive requirements of children of various ages as compared with those 
of adults have been calculated. Those given by Atwater and most 
commonly used in this country are as follows : 

Child under 2 years old requires 0.3 the food of a man at moderately active 
muscular work. 

Child 2-5 years old requires 0.4 the food of a man at moderately active muscu- 
lar work. 

Child 6-9 years old requires 0.5 the food of a man at moderately active muscular 
work. 

Boy 10-11 and girl 10-12 years old require 0.6 the food of a man at moderately 
active muscular work. 

Boy 12, and girl 13-14 years old require 0.7 the food of a man at moderately 
active muscular work. 

Boy 13-14, and girl 15-16 years old require 0.8 the food of a man at moderately 
active muscular work. 

Boy 15-16 years old requires 0.9 the food of a man at moderately active muscu- 
lar work. 

Maurel a , whose work regarding the nutritive requirements in age, 
has already been referred to, has made equally elaborate studies of 
the requirements of children of different ages and weights. He as- 
sumes that, exclusive of the extra requirements occasioned by greater 
body surface, growth, and increasing internal muscular work, the 
protein required for a bare maintenance ration is the same with 
children as with adults in full vigor, namely, 1.5 grams per kilo- 
gram of body weight. In addition, he allows 0.15 gram for in- 
creasing internal muscular work. For growth, 0.10 gram is allowed 
up to 16 years and from 16 to 20 only 0.05 gram. This makes a total 
of 1.75 grams of protein per kilogram of body weight up to the 
age of 16 and from then to 20 years 1.70 grams. There are more varia- 
tions in the amounts of energy required at different ages because the 
ratio of body surface to weight is constantly diminishing. For 
children of 2 years, 67.5 calories per kilogram of body weight is sug- 
gested, with gradually decreasing amounts until at 20 years only 42.75 
calories are called for. Taking Quatelet's figures for the average 
weights of normal children of various ages, Maurel has calculated 
the amounts of protein and energy necessary, and these figures are 
given in the table (p. 97). It should be noted that these body weights 
run lower than the American ones quoted in connection with the Balti- 
more studies (see p. 94). Whether American children really develop 
faster than European, or whether different methods of weighing 
account for the variations is not known, but the heavier weights seem 
safer guides in fixing American standards. While Maurel's mainte- 
nance rations provide for normal growth and the exertion required 
by the performance of involuntary physiological functions, they make 
no allowance for external muscular work. Considering the activity 

a Loc. cit. 



96 

and restlessness of most healthy children, it is probable that this 
would call for considerable extra energy, even though the children 
have no fixed muscular work such as that entailed upon many adults 
by their occupations. It would be practically impossible to estimate 
the energy thus expended, unless possibly by comparisons with and 
deductions from the results of many more dietary studies than are 
now available. Meanwhile, Maurel's figures are not only theoretic- 
ally interesting, but also practically useful as a check on actual 
dietaries. To be on the safe side it would seem that the food should 
be in excess of these maintenance values. 

In attempting to set up or to apply dietary standards for children, 
the question of body weight is more important than in adults, both 
because it is more variable and because it is a measure of the child's 
proper growth and general development. Various estimates of the 
average weight of American children at successive ages have been 
made. Among these may be mentioned those of Boston school chil- 
dren of American parentage, collected by Bowditch, a similar ones by 
Porter a in St. Louis, and those of the large life insurance companies. 
These statistics do not agree as closely as might be wished, differences 
of 1 or 2 pounds sometimes appearing. Whether the differences are 
due to methods of weighing, or whether the variations in children's 
weights are too great to permit of satisfactory averaging, it is impos- 
sible to say. When body weights were not given in the original 
studies those quoted by Holt from life insurance data for children of 
corresponding ages have usually been employed, in the table on 
page 94, as representing the largest number of individuals. In a few 
instances where these were not available those of Bowditch have been 
used. As has already been pointed out, the American figures all run 
higher than the French ones quoted b}^ Maurel ; although there is no 
conclusive explanation of this difference, it will be safer, in applying 
Maurel's maintenance rations to American conditions, to be guided 
by body weight rather than by age. Considering the bad results of 
undernutrition in childhood, the benefit of any possible doubt as to 
the exact requirements of children, especially in institutions, should 
unquestionably be given to the more generous ration. If, as an Eng- 
lish children's specialist, Sir Clement Duke, & insists, " a failure in 
height or weight during growth is the surest indication that the child 
is not thriving," such symptoms occurring where the daily supply oi 
nutrients is known to be rather low, should raise serious doubts as to 
the adequacy of the ration. 

In a study of undernutrition of school children in New York, which 
included some 210 cases, E. M. Sill, c found that they had been living 

a Diseases of Infancy and Childhood. New York, 1902, p. 19. 

6 Remedies for the Needless Injuries to Children, etc. London, 1899. 

c Jour. Amer. Med. Assoc, 52 (1909), p. 1981. 



97 

very largely on bread with tea or coffee; that is, on a diet which was 
presumably low in both protein and energy, and that they were de- 
cidedly under weight— the discrepancy varying from 4 to 16 pounds. 
The children ranged from 3 to 10 years in age — the majority, how- 
ever, being 6 to 10 years old. In addition to hygienic measures, these 
children were provided with a diet containing a generous proportion 
of proteid foods such as milk, eggs, meat, cereals, etc., which resulted 
in gains in weight and very marked improvement in other respects. 

In this connection it may be interesting to see how the commonly 
accepted standards for children's dietaries compare with Maurel's 
maintenance rations, which can be done if the protein and energy per 
kilogram body weight are calculated as in the following table : 

Children's dietary standards expressed per kilogram of hod}/ iccight. 



Child, 2-5 years. 
Child, 6-9 years. 
Boy, 10-11 years 
Boy, 12 years . . . 
Boy, 13-1-1 years 



Grams of 


Calories of 


protein. 


energy. 


2.43 


87. 5 


2.12 


70.0 


2.10 


70.0 


2.09 


69.2 


2.18 


72.5 



G ranis of Calories of 
protein. energy. 



Boy, 15-16 years 

Girl, 10-12 years ... 
Girl, 13-14 years... 
Girl, 15-16 years 



1.77 
2.01 
1.83 
1.66 



58. 7 
67. 1 
60. (i 
55.6 



Maurel's maintenance ration, it will be remembered, calls for 1.75 
grams of protein per kilogram of body weight from birth to the age 
of 16, when it is reduced to 1.70 grams, and amounts of energy grad- 
ually decreasing for 67.50 calories at birth to 44.25 at 16 years. The 
common standard for children from 2 to 5 years of age gives an excess 
of 0.68 gram of protein over this maintenance ration, but this excess 
gradually decreases in the standards for older children, until for 
boys from 15 to 16 years it is only 0.02 gram, while for girls from 15 
to 16 years there is a deficiency of 0.9 gram. Even if we adopt 
Maurel's lowered ration of 1.70 grams per kilogram of body weight 
for children of 16 years, the protein in the last standard for girls 
falls below the maintenance ration. There is a similar but less 
marked decrease in the excess of energy in the usual standards 
over that of the maintenance rations, the excess varying from about 
20 calories per kilogram of body weight in the standard for children 
from 2 to 6 years to 11.3 calories in that for girls of 15 to 16 years. 
The inferences from these comparisons are obvious ; either the Amer- 
ican weights used are too large and the standards for younger chil- 
dren are somewhat excessive, or the standards for older children are 
insufficient to provide for normal amounts of external muscular work. 
"While the weights here used may not be absolutely accurate, there is 
no reason to suppose that they are greatty above the normal for well- 
developed American children. In the opinion of the present writers, 
it is probably nearer the truth, and certainly safer for the present, to 
16553— Bull. 223—10 7 



98 

assume that the standards for older children are a trifle low, espe- 
cially for institution use. 

Reducing the data of the present studies in children's homes as 
summarized in the table on page 94 to the basis of protein and en- 
ergy supplied per kilogram of body weight, we obtain the following 
results : 



Protein and energy per kilogram of body weight in children's dietaries. 


Institution. 


Grams of 
protein. 


Calories of 
energy. 




1.88 
2.15 
2.29 


63.0 


General German Orphan Asylum 


59.3 

63.2 








2.01 


58.7 







In the first of these studies there are only 0.13 gram of protein 
and 9 calories of energy in excess of the amounts set up by Maurel as a 
maintenance ration for children of corresponding weight. In the diet 
of the German Orphan Asylum there is an excess of 0.4 gram protein, 
but only 6.8 calories more energy than in the maintenance ration. In 
the Philadelphia study 0.54 gram of protein and 11.7 calories of 
energy were supplied in excess of Maurel's maintenance ration. 

While it is impossible to estimate the amount of external muscular 
work performed by the children in these studies, they are known to have 
been moderately active, and it seems impossible that their diet can 
have been excessive in either protein or energy. On the other hand, 
it is questionable whether the protein in the first study or the energy 
in the second can have been sufficient for their best development. It 
was noted in the individual discussions of these two studies that while 
the nutrients and energy supplied by the diets corresponded fairly 
closely to the generally accepted standards, the children appeared 
to the observer to be rather below the average in general physical de- 
velopment. While there was little sickness in the institutions, the 
children gave the impression of being younger than they were, and 
this before any effort had been made to weigh them. In the case of 
the German Orphan Asylum the body weights were carefully taken, 
so that there is little likelihood of error from that source. Here again, 
as in the case of the standards for older children, the most reason- 
able deduction seems to be that the present standards for children 
from 9 to 12 years old are a trifle low. Many more observations of 
the diet of normal children are necessary before the exact amounts 
required can be determined. In the light of our present knowledge 
it seems fair to conclude that it would not be wise to allow anything 
below the standard amounts in children's diets, and in most cases 
dietitians would be quite justified in exceeding them somewhat. 

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